Department of Academic Cardiology, Daisy Building, Castle Hill Hospital, Kingston upon Hull, United Kingdom.
Department of Cardiology, Cumberland Infirmary, North Cumbria University Hospitals, Carlisle, United Kingdom.
Curr Vasc Pharmacol. 2019;17(2):191-203. doi: 10.2174/1570161116666180123092054.
The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes.
Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel.
Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men.
In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.
大多数抗血小板治疗试验纳入的患者为男性。本系统评价和荟萃分析旨在确定，除阿司匹林外，P2Y12 抑制剂在急性冠脉综合征的女性和男性患者中是否同样有益。
检索电子数据库，确定了 9 项具有性别特异性临床结局的合格随机对照研究（n=107126 例患者）。计算心血管死亡、心肌梗死或卒中（MACE）复合终点以及大出血安全性终点的风险比（RR）和 95%置信区间（CI）。对替格瑞洛与普拉格雷进行间接比较分析，以进行统计学比较。
与单用阿司匹林相比，氯吡格雷降低了男性患者的 MACE（RR，0.79；95%CI，0.68 至 0.92；p=0.003），但在女性患者中无统计学意义（RR，0.88；95%CI，0.75 至 1.02，p=0.08）。氯吡格雷治疗显著增加了女性患者的出血风险，但未增加男性患者的出血风险。与氯吡格雷相比，普拉格雷在男性患者中有益（RR，0.84；95%CI，0.73 至 0.97；p=0.02），但在女性患者中无统计学意义（RR，0.94；95%CI，0.83 至 1.06；p=0.30）；替格瑞洛降低了男性（RR，0.85；95%CI，0.77 至 0.94；p=0.001）和女性（RR，0.84；95%CI，0.73 至 0.97；p=0.02）患者的 MACE。间接比较表明，在任何性别中，替格瑞洛与普拉格雷之间均无显著差异。与氯吡格雷相比，替格瑞洛和普拉格雷增加了女性和男性患者的出血风险。
总而言之，与阿司匹林单药治疗相比，P2Y12 抑制剂可降低女性和男性患者的 MACE。替格瑞洛在两性中均优于氯吡格雷。普拉格雷仅在男性中具有统计学意义的获益；然而，间接比较并未显示替格瑞洛在女性中优于普拉格雷。
