Jia Min, Li Zaibo, Chu Hongtao, Li Lin, Chen Keyong
Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).
Med Sci Monit. 2015 Apr 20;21:1131-7. doi: 10.12659/MSM.893914.
Whether prasugrel can take the place of clopidogrel for patients with acute coronary syndrome (ACS) is not clear. The aim of this study was to perform a meta-analysis for systematically reviewing the evidence on prasugrel in comparison to clopidogrel in patients with ACS.
MATERIAL/METHODS: Relevant prospective and retrospective studies were searched in databases. Six studies were finally included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess all causes of death, myocardial infarction (MI), stroke, major bleeding, major/minor bleeding, and stent thrombosis (for PCI performed).
Compared with clopidogrel, prasugrel had similar risks of all cause of death (Pooled RR: 0.83; 95% CI: 0.64-1.06, p=0.14, I2=55%), MI (Pooled RR: 0.86; 95% CI: 0.71-1.04, p=0.12) and stroke (pooled RR: 0.88; 95% CI: 0.70-1.10, p=0.25). However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95% CI: 0.99-1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15-1.48, p<0.0001, I2=0%). For the patients who underwent percutaneous coronary intervention (PCI), prasugrel was associated with significantly lower risk of stent thrombosis (Pooled RR: 0.47; 95% CI: 0.34-0.61, p<0.00001, I2=0%).
Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients. For the patients who underwent PCI, prasugrel contributes to lower risk of stent thrombosis. However, prasugrel is associated with significantly higher risk of bleeding. For the patients with active pathological bleeding or a history of stroke and/or TIA, prasugrel should not be recommended.
普拉格雷能否替代氯吡格雷用于急性冠状动脉综合征（ACS）患者尚不清楚。本研究旨在进行一项荟萃分析，以系统回顾ACS患者中普拉格雷与氯吡格雷对比的相关证据。
材料/方法：在数据库中检索相关前瞻性和回顾性研究。最终纳入6项研究。计算合并风险比（RRs）及95%置信区间（CIs），以评估全因死亡、心肌梗死（MI）、卒中、大出血、大/小出血及支架血栓形成（针对接受经皮冠状动脉介入治疗[PCI]者）的所有病因。
与氯吡格雷相比，普拉格雷在全因死亡风险（合并RR：0.83；95%CI：0.64 - 1.06，p = 0.14，I² = 55%）、心肌梗死风险（合并RR：0.86；95%CI：0.71 - 1.04，p = 0.12）及卒中风险（合并RR：0.88；95%CI：0.70 - 1.10，p = 0.25）方面相似。然而，普拉格雷的大出血风险（合并RR：1.19；95%CI：0.99 - 1.44，p = 0.06，I² = 0%）及大/小出血总风险（合并RR：1.30；95%CI：1.15 - 1.48，p < 0.0001，I² = 0%）显著更高。对于接受PCI的患者，普拉格雷的支架血栓形成风险显著更低（合并RR：0.47；95%CI：0.34 - 0.61，p < 0.00001，I² = 0%）。
在ACS患者的全因死亡、心肌梗死及卒中方面，普拉格雷与氯吡格雷效果相似。对于接受PCI的患者，普拉格雷可降低支架血栓形成风险。然而，普拉格雷的出血风险显著更高。对于有活动性病理性出血或有卒中及/或短暂性脑缺血发作（TIA）病史的患者，不应推荐使用普拉格雷。
