Efficacy and safety of clopidogrel versus ticagrelor as part of dual antiplatelet therapy in acute coronary syndrome - a systematic review and meta-analysis.

• The efficacy and safety of clopidogrel compared with ticagrelor as part of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome is reviewed. PubMed, Embase, the Cochrane Library, Medline, and HTA databases were searched (Sep 2nd 2020) for randomised controlled trials (RCTs). ACS patients subjected to clopidogrel or ticagrelor as part of DAPT were included. Pooled risk-differences were estimated using random-effects meta-analyses, and certainty of evidence was assessed according to GRADE. In ACS patients subjected to DAPT, the pooled risk difference for all-cause mortality was 0·6% (-0·03% to 1·3%; I2: 18%); cardiovascular mortality: 0·6% (0·01% to 1·1%; I2: 22%); MI: 0·9% (0·4% to 1·3%; I2: 5%); stent thrombosis: 0·7% (0·4 to 1·1%; I2: 0%); clinically significant bleeding: -1·9% (-3·7% to -0·2%; I2: 69%); major bleeding: -0·9% (-1·6% to -0·1%; I2: 32%); and dyspnea: -5·8% (-7·7% to -3·8%; I2: 63%). In the subgroup of older patients there were no differences between the comparison groups regarding all-cause mortality, CV mortality and MI, whereas the risk of clinically significant bleeding and major bleeding was lower in the clopidogrel group, -5·9% (-11 to -0·9%, 1 RCT) and -2·4% (-4·4% to -0·3%, I2: 0%), respectively. Compared with ticagrelor, clopidogrel may result in little or no difference regarding all-cause mortality. In older patients, clopidogrel may be slightly less efficient in reducing the risk of cardiovascular mortality and MI. Clopidogrel results in a reduced risk of bleedings and dyspnea.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

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