Dave Shivani, Choudhari Jashkumar, Kakkar Arman, Parmar Mayur S, Machini Matthew
Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, Florida, USA.
Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA.
Eur J Pharmacol. 2025 Sep 15;1003:177955. doi: 10.1016/j.ejphar.2025.177955. Epub 2025 Jul 17.
Ticagrelor is a potent antiplatelet drug that emerged as an alternative to clopidogrel in the management of patients with acute coronary syndrome (ACS) and post-myocardial infarction (post-MI). This meta-analysis aims to comprehensively assess the safety and efficacy of ticagrelor compared to clopidogrel in this patient population. We systematically searched multiple databases and included eight randomized controlled trials (RCTs) comparing ticagrelor and clopidogrel in ACS and post-MI patients undergoing PCI. The primary efficacy endpoints were stent thrombosis and revascularization, while the primary safety endpoints were major adverse cardiovascular events (MACE) and mortality. Ticagrelor significantly reduced stent thrombosis compared to clopidogrel (OR 0.71, 95 % CI 0.53-0.94, I = 23 %) and a non-significant trends toward reduced revascularization (OR 0.74, 95 % CI 0.45-1.21, I = 61 %) and MACE (OR 0.85, 95 % CI 0.69-1.04, I = 67 %), limited by moderate to high heterogeneity. Conversely, ticagrelor was associated with a clinically meaningful reduction in mortality compared to clopidogrel (OR 0.85, 95 % CI 0.75-0.95, I = 0 %). This meta-analysis suggests that ticagrelor is a more effective option than clopidogrel in preventing stent thrombosis and demonstrates a significant reduction in mortality in patients with ACS and post-MI undergoing PCI. While a non-significant trend towards lower revascularization and MACE was observed with ticagrelor, high heterogeneity and a lack of statistical significance for these outcomes preclude definitive conclusions. Overall, ticagrelor's consistent benefits in preventing stent thrombosis and reducing mortality support its consideration as a preferred option, alongside individualized treatment decisions that account for patient-specific factors, risk profiles, and clinical outcomes.
替格瑞洛是一种强效抗血小板药物，在急性冠状动脉综合征（ACS）和心肌梗死后（心肌梗死后）患者的管理中作为氯吡格雷的替代品出现。这项荟萃分析旨在全面评估替格瑞洛与氯吡格雷相比在该患者群体中的安全性和有效性。我们系统地检索了多个数据库，并纳入了八项比较替格瑞洛和氯吡格雷在接受PCI的ACS和心肌梗死后患者中的随机对照试验（RCT）。主要疗效终点是支架血栓形成和血运重建，而主要安全终点是主要不良心血管事件（MACE）和死亡率。与氯吡格雷相比，替格瑞洛显著降低了支架血栓形成（OR 0.71，95%CI 0.53 - 0.94，I = 23%），并且在血运重建（OR 0.74，95%CI 0.45 - 1.21，I = 61%）和MACE（OR 0.85，95%CI 0.69 - 1.04，I = 67%）方面有降低的非显著趋势，受中度至高度异质性限制。相反，与氯吡格雷相比，替格瑞洛与临床上有意义的死亡率降低相关（OR 0.85，95%CI 0.75 - 0.95，I = 0%）。这项荟萃分析表明，替格瑞洛在预防支架血栓形成方面比氯吡格雷更有效，并且在接受PCI的ACS和心肌梗死后患者中死亡率显著降低。虽然观察到替格瑞洛在血运重建和MACE方面有降低的非显著趋势，但这些结果的高异质性和缺乏统计学意义排除了确定性结论。总体而言，替格瑞洛在预防支架血栓形成和降低死亡率方面的持续益处支持将其视为首选选项，同时结合考虑患者特定因素、风险概况和临床结果的个体化治疗决策。
