Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Thoracic Cardiovascular Surgery, The Affiliated Hospital of Xuzhou Medical University, XuZhou, JiangSu, China.
Postgrad Med J. 2020 Nov;96(1141):693-702. doi: 10.1136/postgradmedj-2019-137180. Epub 2020 Jun 19.
Our aim was to examine clinical trials, provide guidance to practitioners and estimate the efficacy and safety of two agents by comparing low dose ticagrelor with standard dose clopidogrel in patients with acute coronary syndrome. We systematically looked through Pubmed, Embase, the Cochrane Library, Wanfang data and CNKI for trials comparing low dose ticagrelor with standard dose clopidogrel for the treatment of patients with ACS since the database was created. The primary endpoint for efficacy was the rate of major adverse cardiac events (MACEs). The primary endpoint for safety was the rate of major bleeding events. We also evaluated platelet function between low dose ticagrelor and standard dose clopidogrel in ACS patients. From 6744 articles, 16 studies including 1629 patients met the inclusion criteria. In contrast with standard dose clopidogrel, low dose ticagrelor significantly reduced MACEs (OR 0.39, 95% CI 0.26, 0.58) and the difference was statistically significant (p<0.01). No difference was noted for major bleeding events (OR 1.16, 95% CI 0.43, 3.08) between the two agents (p=0.77). In addition, low dose ticagrelor showed lower platelet aggregation rate than clopidogrel (standardised mean difference (SMD) -0.68, 95% CI -0.83 to 0.53) (p<0.01). Platelet reaction units for low dose ticagrelor were much lower than those for standard dose clopidogrel (SMD -2.46, 95% CI -2.85 to -2.07) (p<0.01). In comparison with standard dose clopidogrel, low dose ticagrelor significantly lowered the incidence of MACEs, improved left ventricular ejection fraction, decreased left ventricular end diastolic dimension and did not expand the risk of major bleeding events or minor or minimal bleeding events in ACS patients with a considerable safety and efficacy profile. In addition, low dose ticagrelor was associated with dramatically lower platelet aggregation compared with standard dose clopidogrel.
我们的目的是通过比较急性冠脉综合征（ACS）患者低剂量替格瑞洛与标准剂量氯吡格雷，来评估临床试验，为临床医生提供指导，并评估两种药物的疗效和安全性。我们系统地检索了 Pubmed、Embase、Cochrane 图书馆、万方数据和中国知网（CNKI），检索自数据库建立以来比较低剂量替格瑞洛与标准剂量氯吡格雷治疗 ACS 患者的试验。疗效的主要终点是主要不良心脏事件（MACEs）的发生率。安全性的主要终点是主要出血事件的发生率。我们还评估了 ACS 患者中低剂量替格瑞洛与标准剂量氯吡格雷之间的血小板功能。从 6744 篇文章中，有 16 项研究（包括 1629 名患者）符合纳入标准。与标准剂量氯吡格雷相比，低剂量替格瑞洛显著降低了 MACEs（OR 0.39，95%CI 0.26，0.58），差异有统计学意义（p<0.01）。两种药物之间主要出血事件无差异（OR 1.16，95%CI 0.43，3.08）（p=0.77）。此外，低剂量替格瑞洛的血小板聚集率低于氯吡格雷（标准化均数差（SMD）-0.68，95%CI -0.83 至 0.53）（p<0.01）。低剂量替格瑞洛的血小板反应单位明显低于标准剂量氯吡格雷（SMD -2.46，95%CI -2.85 至 -2.07）（p<0.01）。与标准剂量氯吡格雷相比，低剂量替格瑞洛显著降低了 MACEs 的发生率，改善了左心室射血分数，降低了左心室舒张末期内径，在 ACS 患者中没有增加主要出血事件或轻微或最小出血事件的风险，具有相当的安全性和疗效。此外，与标准剂量氯吡格雷相比，低剂量替格瑞洛的血小板聚集明显降低。
