Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, 48503, USA.
, Flint, MI, USA.
J Thromb Thrombolysis. 2018 Oct;46(3):299-303. doi: 10.1007/s11239-018-1706-2.
Dual antiplatelet therapy with aspirin and clopidogrel are recommended as adjuncts to fibrinolytic-treated patients with ST-elevation myocardial infarction (STEMI). However, the role of switching to ticagrelor within 24 h of fibrinolytics compared with clopidogrel continuation in this setting is uncertain. Hence, we conducted a comprehensive search of electronic databases for all randomized clinical trials (RCTs) that evaluated the safety and efficacy of ticagrelor versus clopidogrel after fibrinolytic therapy in patients with STEMI. A random-effects model was used to calculate the risk ratios (RRs) and 95% confidence intervals (CIs). A total of 5 RCTs that evaluated the efficacy of ticagrelor post-fibrinolysis were identified. We included 3 RCTs with 3999 total patients for our meta-analysis. The results showed similar short-term clinical outcomes between ticagrelor and clopidogrel with regard to rates of Bleeding Academic Research Consortium (BARC) type ≥ 2 bleeding (RR 0.94; 95% CI 0.56-1.60; P = 0.83), major adverse cardiovascular events (RR 0.87; 95% CI 0.49-1.52; P = 0.62), mortality (RR 0.92; 95% CI 0.53-1.59; P = 0.77), myocardial infarction (RR 0.76; 95% CI 0.43-1.36; P = 0.36), and stroke (RR 0.93; 95% CI 0.50-1.73; P = 0.82). Our results demonstrate that in STEMI patients treated with fibrinolytic therapy, switching to ticagrelor was associated with similar bleeding and ischemic outcomes compared with clopidogrel continuation.
双重抗血小板治疗，即阿司匹林和氯吡格雷，被推荐作为 ST 段抬高型心肌梗死（STEMI）患者溶栓治疗的辅助手段。然而，在这种情况下，溶栓后 24 小时内将氯吡格雷转换为替格瑞洛与继续使用氯吡格雷相比，其疗效尚不确定。因此，我们对所有评估溶栓治疗后替格瑞洛与氯吡格雷在 STEMI 患者中的安全性和疗效的随机临床试验（RCT）进行了全面的电子数据库检索。使用随机效应模型计算风险比（RR）和 95%置信区间（CI）。共确定了 5 项评估溶栓后替格瑞洛疗效的 RCT。我们纳入了 3 项共 3999 例患者的 RCT 进行荟萃分析。结果显示，替格瑞洛与氯吡格雷在短期临床结局方面相似，BARC 类型≥2 出血（RR 0.94；95%CI 0.56-1.60；P=0.83）、主要不良心血管事件（RR 0.87；95%CI 0.49-1.52；P=0.62）、死亡率（RR 0.92；95%CI 0.53-1.59；P=0.77）、心肌梗死（RR 0.76；95%CI 0.43-1.36；P=0.36）和卒中（RR 0.93；95%CI 0.50-1.73；P=0.82）的发生率相似。我们的结果表明，在接受溶栓治疗的 STEMI 患者中，与继续使用氯吡格雷相比，转换为替格瑞洛与出血和缺血性结局相似。
