替格瑞洛对比氯吡格雷治疗东亚ACS患者有效性和安全性的Meta分析

Efficacy and Safety of Ticagrelor Versus Clopidogrel in the Treatment of ACS Patients in East Asia:A Meta-analysis

目的:系统性评价替格瑞洛对比氯吡格雷治疗东亚急性冠状动脉综合征(ACS)患者的有效性和安全性,旨在为临床用药提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、中国知网、万方数据库等,收集替格瑞洛(试验组)对比氯吡格雷(对照组)治疗东亚ACS患者的随机对照试验(RCT)。筛选文献、提取数据后采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具对纳入文献进行质量评价,采用Rev Man 5.3统计软件进行Meta分析。结果:共纳入5项RCT,共计4511例患者。Meta分析结果显示,两组患者主要心血管不良事件发生率[OR=0.85,95%CI(0.68,1.04),P=0.12]、心血管原因死亡率[OR=0.76,95%CI(0.57,1.03),P=0.08]、脑卒中发生率[OR=0.77,95%CI(0.48,1.24),P=0.28]比较,差异均无统计学意义;试验组患者主要出血事件发生率[OR=1.54,95%CI(1.19,1.99),P=0.001]、次要出血事件发生率[OR=1.80,95%CI(1.40,2.32),P<0.00001]均显著高于对照组。结论:替格瑞洛在降低东亚ACS患者的主要心血管不良事件、心血管原因死亡以及脑卒中的发生风险等方面的作用与氯吡格雷相当,但该药会增加患者主要出血、次要出血事件的发生风险。

OBJECTIVE:To systematically evaluate the effectiveness and safety of ticagrelor versus clopidogrel in the treatment of acute coronary syndrome(ACS)patients in East Asia,and to provide evidence-based references for clinical drug use.METHODS:Retrieved from Cochrane Library,PubMed,Embase,CNKI,Wanfang database,etc.,randomized controlled trials(RCTs)about ticagrelor(trial group)versus clopidogrel(control group)in the treatment of ACS patients in east Asia were collected.After literature screening and data extraction,the quality of included literatures was evaluated by using biasrisk evaluation tool recommended by Cochrane system evaluation manual 5.1.0,and Meta-analysis was performed by using Rev Man 5.3 statistical software.RESULTS:A total of 5 RCTs were included,with a total of 4511 cases.Meta-analysis showed that the incidence of major adverse cardiovascular events[OR=0.85,95%CI(0.68,1.04),P=0.12],the incidence of death from cardiovascular causes[OR=0.76,95%CI(0.57,1.03),P=0.08]and the incidence of stroke[OR=0.77,95%CI(0.48,1.24),P=0.28],without statistical significance.The incidence of major bleeding events[OR=1.54,95%CI(1.19,1.99),P=0.001]and minor bleeding events[OR=1.80,95%CI(1.40,2.32),P<0.00001]in trial group were significantly higher than control group.CONCLUSIONS:Ticagrelor is comparable to clopidogrel in reduce the major adverse cardiovascular events,death from cardiovascular causes and stroke in ACS patients in East Asian,but it can increase the risk of major and minor bleeding events.