Bundhun Pravesh Kumar, Shi Jia-Xin, Huang Feng
Institute of Cardiovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530027, People's Republic of China.
Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, People's Republic of China.
BMC Pharmacol Toxicol. 2017 Dec 12;18(1):80. doi: 10.1186/s40360-017-0189-7.
Prasugrel and Ticagrelor are emerging antiplatelet drugs that might have the potential to replace currently used antiplatelet agents. Previous analyses comparing prasugrel with ticagrelor mainly focused on an indirect comparison whereas direct comparison was reported only in a few recently published trials. We aimed to systematically carry out a head to head comparison of the adverse clinical outcomes which were associated with prasugrel versus ticagrelor in patients with acute coronary syndrome (ACS).
Studies comparing prasugrel with ticagrelor (head to head comparison) were searched from online databases. Adverse cardiovascular outcomes were considered as the primary endpoints whereas bleeding outcomes were considered as the secondary endpoints in this analysis. The latest version of the RevMan software was used to carry out subgroup analyses whereby odds ratios (OR) with 95% confidence intervals (CI) and the calculated probability (P) were generated.
Four studies with a total number of 563 patients (2012 - 2016) were included (282 patients were treated with prasugrel and 281 patients were treated with ticagrelor). Results of this analysis did not show any significant difference in mortality between prasugrel and ticagrelor with OR: 1.52, 95% CI: 0.42 - 5.45; P = 0.52. In addition, myocardial infarction, major adverse cardiac events, stroke and stent thrombosis were also not significantly different with OR: 0.59, 95% CI: 0.08 - 4.58; P = 0.62, OR: 0.91, 95% CI: 0.37 - 2.21; P = 0.83, OR: 0.60, 95% CI: 0.08 - 4.58; P = 0.62 and OR: 0.59, 95% CI: 0.08 - 4.58; P = 0.62 respectively. Thrombolysis in myocardial infarction (TIMI) defined minor bleeding, and minimal bleeding were also not significantly different between these two newer antiplatelet agents with OR: 3.11, 95% CI: 0.48 - 19.94; P = 0.23, and OR: 2.39, 95% CI: 0.35 - 16.42; P = 0.38 respectively. Moreover, bleeding defined by the academic research consortium was also similarly manifested with OR: 0.92, 95% CI: 0.39 - 2.13; P = 0.84.
In patients with ACS, both prasugrel and ticagrelor showed similar adverse cardiovascular outcomes and bleeding events. No significant difference was observed between these two newer antiplatelet agents during this head to head comparison. However, upcoming trials with long term follow up periods might be expected to completely solve this important clinical issue.
普拉格雷和替格瑞洛是新型抗血小板药物，可能有潜力取代目前使用的抗血小板药物。以往比较普拉格雷与替格瑞洛的分析主要集中在间接比较上，而直接比较仅在最近发表的少数试验中有所报道。我们旨在系统地对急性冠状动脉综合征（ACS）患者中与普拉格雷和替格瑞洛相关的不良临床结局进行直接比较。
从在线数据库中检索比较普拉格雷与替格瑞洛（直接比较）的研究。本分析中，不良心血管结局被视为主要终点，而出血结局被视为次要终点。使用RevMan软件的最新版本进行亚组分析，得出比值比（OR）及95%置信区间（CI）和计算概率（P）。
纳入了4项研究，共563例患者（2012 - 2016年）（282例患者接受普拉格雷治疗，281例患者接受替格瑞洛治疗）。该分析结果显示，普拉格雷和替格瑞洛在死亡率方面无显著差异，OR为1.52，95%CI为0.42 - 5.45；P = 0.52。此外，心肌梗死、主要不良心脏事件、中风和支架血栓形成也无显著差异，OR分别为0.59，95%CI为0.08 - 4.58；P = 0.62，OR为0.91，95%CI为0.37 - 2.21；P = 0.83，OR为0.60，95%CI为0.08 - 4.58；P = 0.62，OR为0.59，95%CI为0.08 - 4.58；P = 0.62。心肌梗死溶栓（TIMI）定义的轻微出血和微量出血在这两种新型抗血小板药物之间也无显著差异，OR分别为3.11，95%CI为0.48 - 19.94；P = 0.23，以及OR为2.39，95%CI为0.35 - 16.42；P = 0.38。此外，学术研究联盟定义的出血情况也相似，OR为0.92，95%CI为0.39 - 2.13；P = 0.84。
在ACS患者中，普拉格雷和替格瑞洛显示出相似的不良心血管结局和出血事件。在这次直接比较中，这两种新型抗血小板药物之间未观察到显著差异。然而，预计即将进行的长期随访试验可能会完全解决这一重要的临床问题。
