Safety and Efficacy of Selective, Clopidogrel-Based Strategies in Acute Coronary Syndrome: A Study-Level Meta-analysis.
Thromb Haemost
; 122(10): 1732-1743, 2022 Oct.
Article
em En
| MEDLINE
| ID: mdl-35436797
ABSTRACT
OBJECTIVES:
To investigate outcomes with selective, clopidogrel-based therapies versus conventional treatment in patients undergoing percutaneous coronary intervention (PCI), especially for acute coronary syndrome.BACKGROUND:
Safety and efficacy of alternative, selective, clopidogrel-based therapies after PCI are not robustly established.METHODS:
We performed a study-level meta-analysis on six randomized trials investigating selective clopidogrel-based therapies (three on unguided de-escalation, N = 3,473; three on guided clopidogrel therapy, N = 7,533). Control groups received ticagrelor or prasugrel treatment. Main endpoints were major bleeding, any bleeding, major adverse cardiovascular events (MACE), and net clinical endpoint.RESULTS:
The incidence of major bleeding and MACE was similar in the selective, clopidogrel-based therapy versus the conventional treatment arm (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.51-1.01, p = 0.06; OR 0.93, 0.72-1.20, p = 0.58; respectively). The rates of any bleeding were lower in the selective, clopidogrel-based therapy versus conventional treatment group (OR 0.57, 95% CI 0.40-0.80, p = 0.001); this greater safety was significant for unguided de-escalation (OR 0.43, 95% CI 0.32-0.58, p = 0.00001) and nonsignificant for guided clopidogrel therapy (OR 0.72, 95% CI 0.51-1.02, p = 0.07; p for interaction 0.03). The incidence of the net clinical endpoint was fewer in the selective, clopidogrel-based therapy versus the conventional treatment arm (OR 0.59, 95% CI 0.41-0.85, p = 0.004); this benefit was significant for unguided de-escalation (OR 0.50, 95% CI 0.39-0.64, p < 0.00001) and nonsignificant for guided clopidogrel therapy (OR 0.85, 95% CI 0.62-1.16, p = 0.30; p for interaction 0.01).CONCLUSION:
As compared with prasugrel/ticagrelor treatment, alternative, selective, clopidogrel-based approaches provide a similar protection from cardiovascular events, reduce the risk of any bleeding, and are associated with a greater net benefit. These beneficial effects were prevalent with unguided de-escalation to clopidogrel.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Síndrome Coronariana Aguda
/
Intervenção Coronária Percutânea
Tipo de estudo:
Clinical_trials
/
Etiology_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Thromb Haemost
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Itália