老年患者的冠心病：选择哪种药物，替格瑞洛还是氯吡格雷？一项随机对照试验的系统评价和荟萃分析
Coronary Heart Disease (CHD) in Elderly Patients: Which Drug to Choose, Ticagrelor and Clopidogrel? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
作者信息
Akkaif Mohammed Ahmed, Sha'aban Abubakar, Daud Nur Aizati Athirah, Yunusa Ismaeel, Ng Mei Li, Sk Abdul Kader Muhamad Ali, Noor Dzul Azri Mohamed, Ibrahim Baharudin
机构信息
Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia.
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria 810107, Nigeria.
出版信息
J Cardiovasc Dev Dis. 2021 Sep 30;8(10):123. doi: 10.3390/jcdd8100123.
BACKGROUND
A new generation P2Y12 receptor inhibitor (ticagrelor) is recommended in current therapeutic guidelines to treat patients with coronary heart disease (CHD). However, it is unknown if ticagrelor is more effective than clopidogrel in elderly patients. Therefore, a systematic review was done to assess the effectiveness and safety of ticagrelor and clopidogrel in older patients with CHD to determine the appropriate antiplatelet treatment plan.
METHODOLOGY
We performed a systematic review of randomized controlled trials (RCTs) to compare the effectiveness and safety of ticagrelor vs. clopidogrel in elderly patients with CHD. We selected eligible RCTs based on specified study criteria following a systematic search of PubMed and Scopus databases from January 2007 to May 2021. Primary efficacy outcomes assessed were major adverse cardiovascular events (MACEs), myocardial infarction (MI), stent thrombosis (ST), and all-cause death. The secondary outcome assessed was major bleeding events. We used RevMan 5.3 software to conduct a random-effects meta-analysis and estimated the pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs) for ticagrelor and clopidogrel.
RESULTS
Data from 6 RCTs comprising 21,827 elderly patients were extracted according to the eligibility criteria. There was no significant difference in the MACE outcome (incidence: 9.23% vs. 10.57%; RR = 0.95, 95% CI = 0.70-1.28, = 0.72), MI (incidence: 5.40% vs. 6.23%; RR = 0.94, 95% CI= 0.69-1.27, = 0.67), ST (incidence: 2.33% vs. 3.17%; RR = 0.61, 95% CI= 0.32-1.17, = 0.13), and all-cause death (4.29% vs. 5.33%; RR = 0.86, 95% CI = 0.65-1.12, = 0.25) for ticagrelor vs. clopidogrel, respectively. In addition, ticagrelor was not associated with a significant increase in the rate of major bleeding (incidence: 9.98% vs. 9.33%: RR = 1.37, 95% CI = 0.97-1.94, = 0.07) vs. clopidogrel.
CONCLUSIONS
This study did not find evidence that ticagrelor is significantly more effective or safer than clopidogrel in elderly patients with CHD.
背景
当前治疗指南推荐使用新一代P2Y12受体抑制剂（替格瑞洛）治疗冠心病（CHD）患者。然而，替格瑞洛在老年患者中是否比氯吡格雷更有效尚不清楚。因此，进行了一项系统评价，以评估替格瑞洛和氯吡格雷在老年冠心病患者中的有效性和安全性，从而确定合适的抗血小板治疗方案。
方法
我们对随机对照试验（RCT）进行了系统评价，以比较替格瑞洛与氯吡格雷在老年冠心病患者中的有效性和安全性。在对2007年1月至2021年5月的PubMed和Scopus数据库进行系统检索后，我们根据特定的研究标准选择了符合条件的RCT。评估的主要疗效结局为主要不良心血管事件（MACE）、心肌梗死（MI）、支架血栓形成（ST）和全因死亡。评估的次要结局为主要出血事件。我们使用RevMan 5.3软件进行随机效应荟萃分析，并估计替格瑞洛和氯吡格雷的合并发生率及风险比（RR），并给出95%置信区间（CI）。
结果
根据纳入标准，从6项RCT中提取了21827例老年患者的数据。替格瑞洛与氯吡格雷相比，在MACE结局（发生率：9.23%对10.57%；RR = 0.95，95%CI = 0.70 - 1.28，P = 0.72）、MI（发生率：5.40%对6.23%；RR = 0.94，95%CI = 0.69 - 1.27，P = 0.67）、ST（发生率：2.33%对3.17%；RR = 0.61，95%CI = 0.32 - 1.17，P = 0.13）和全因死亡（4.29%对5.33%；RR = 0.86，95%CI = 0.65 - 1.12，P = 0.25）方面均无显著差异。此外，与氯吡格雷相比，替格瑞洛并未导致主要出血发生率显著增加（发生率：9.98%对9.33%：RR = 1.37，95%CI = 0.97 - 1.94，P = 0.07）。
结论
本研究未发现证据表明替格瑞洛在老年冠心病患者中比氯吡格雷更有效或更安全。
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