We performed a meta-analysis of randomized controlled trials（RCTs） to investigate the efficacy and safety of ticagrelor（TIC） vs. clopidogrel（CLO） in patients undergoing percutaneous coronary intervention（PCI）....We performed a meta-analysis of randomized controlled trials（RCTs） to investigate the efficacy and safety of ticagrelor（TIC） vs. clopidogrel（CLO） in patients undergoing percutaneous coronary intervention（PCI）. In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality（MD=0.83, 95%CI=0.74–0.93, P=0.001） and myocardial infarction（MI）（MD=0.78, 95%CI=0.70–0.88, P=0.000）. There were no significant differences in stroke（MD=1.34, 95%CI=0.99–1.79, P=0.06）, total bleeding（MD=0.97, 95%CI=0.84–1.12, P=0.66）, minor or major bleeding（MD=1.06, 95%CI=0.94–1.19, P=0.35） in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.展开更多
Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variabl...Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variable individual responsiveness and by new,more potent competitors,such as prasugrel and ticagrelor. But what is the actual body of evidence in support of clopidogrel?Is there any dark side of the moon?What is the role of prasugrel,which has already been approved in Europe and in the United States?And what will be the future role of ticagrelor,when approved for routine clinical practice?We hereby concisely summarize the scope of this clinical choice,providing arguments in favor and against each of the three antiplatelet agents:clopidogrel,prasugrel,and ticagrelor.展开更多
目的:系统评价氯吡格雷或替格瑞洛治疗心肌梗死的疗效及安全性。方法:计算机检索PubMed、Cochrane Library、CNKI等数据库,收集氯吡格雷和替格瑞洛的RCT、队列研究文献。采用Downs and Black工具质量评价对纳入的文献进行质量评价后提...目的:系统评价氯吡格雷或替格瑞洛治疗心肌梗死的疗效及安全性。方法:计算机检索PubMed、Cochrane Library、CNKI等数据库,收集氯吡格雷和替格瑞洛的RCT、队列研究文献。采用Downs and Black工具质量评价对纳入的文献进行质量评价后提取数据进行Meta统计分析。结果:Meta分析结果显示,氯吡格雷术后血流通量TIMIⅢ级显著低于替格瑞洛组[OR=0.31,95%CI(0.23~0.42),P<0.00001];氯吡格雷术后出血事件显著低于替格瑞洛组[OR=0.67,95%CI (0.59~0.76),P<0.00001];替格瑞洛组主要心血管不良事件的发生率低[RR=1.22,95%CI(1.10~1.35),P=0.0001];不良反应事件氯吡格雷组发生率低[OR=1.15,95%CI(1.03~1.30),P=0.01];死亡事件二者无显著性差异[RR=0.93,95%CI(0.80~1.08),P=0.35]。结论:氯吡格雷较替格瑞洛在心肌梗死患者治疗中的有效性相对较差,但安全性方面相对较优。展开更多
基金supported by the grants from the National Natural Science Foundation of China(No.81470387)Hubei Province’s Outstanding Medical Academic Leader Program,China
文摘We performed a meta-analysis of randomized controlled trials（RCTs） to investigate the efficacy and safety of ticagrelor（TIC） vs. clopidogrel（CLO） in patients undergoing percutaneous coronary intervention（PCI）. In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality（MD=0.83, 95%CI=0.74–0.93, P=0.001） and myocardial infarction（MI）（MD=0.78, 95%CI=0.70–0.88, P=0.000）. There were no significant differences in stroke（MD=1.34, 95%CI=0.99–1.79, P=0.06）, total bleeding（MD=0.97, 95%CI=0.84–1.12, P=0.66）, minor or major bleeding（MD=1.06, 95%CI=0.94–1.19, P=0.35） in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.
文摘Clopidogrel is a mainstay in the treatment of patients with acute coronary syndromes or those receiving endovascular prostheses.However,its efficacy has been challenged in the recent past by studies suggesting variable individual responsiveness and by new,more potent competitors,such as prasugrel and ticagrelor. But what is the actual body of evidence in support of clopidogrel?Is there any dark side of the moon?What is the role of prasugrel,which has already been approved in Europe and in the United States?And what will be the future role of ticagrelor,when approved for routine clinical practice?We hereby concisely summarize the scope of this clinical choice,providing arguments in favor and against each of the three antiplatelet agents:clopidogrel,prasugrel,and ticagrelor.
文摘目的:系统评价氯吡格雷或替格瑞洛治疗心肌梗死的疗效及安全性。方法:计算机检索PubMed、Cochrane Library、CNKI等数据库,收集氯吡格雷和替格瑞洛的RCT、队列研究文献。采用Downs and Black工具质量评价对纳入的文献进行质量评价后提取数据进行Meta统计分析。结果:Meta分析结果显示,氯吡格雷术后血流通量TIMIⅢ级显著低于替格瑞洛组[OR=0.31,95%CI(0.23~0.42),P<0.00001];氯吡格雷术后出血事件显著低于替格瑞洛组[OR=0.67,95%CI (0.59~0.76),P<0.00001];替格瑞洛组主要心血管不良事件的发生率低[RR=1.22,95%CI(1.10~1.35),P=0.0001];不良反应事件氯吡格雷组发生率低[OR=1.15,95%CI(1.03~1.30),P=0.01];死亡事件二者无显著性差异[RR=0.93,95%CI(0.80~1.08),P=0.35]。结论:氯吡格雷较替格瑞洛在心肌梗死患者治疗中的有效性相对较差,但安全性方面相对较优。
