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TICAGRELOR VERSUS PRASUGREL IN PATIENTS WITH ACUTE CORONARY SYNDROME: AN INSIGHT FROM A NETWORK META-ANALYSIS
Abstract   Open access   Peer reviewed

TICAGRELOR VERSUS PRASUGREL IN PATIENTS WITH ACUTE CORONARY SYNDROME: AN INSIGHT FROM A NETWORK META-ANALYSIS

Mohammed Osman, Sudarshan Balla, Babikir Kheiri, Peter Farjo, Yasir Abdul Ghaffar, Amanda Jo Shigle, Kinjan Patel, Firas Zahr and Mohamad Alkhouli
Journal of the American College of Cardiology, Vol.75(11 Supplement 1), pp.68-68
03/24/2020
DOI: 10.1016/S0735-1097(20)30695-1
url
https://doi.org/10.1016/S0735-1097(20)30695-1View
Published (Version of record) Open Access

Abstract

Background With the exception of ISAR-REACT 5 trial, majority of randomized trials (RCTs) compared third generation P2Y12 inhibitors (Prasugrel and Ticagrelor) to Clopidogrel. We performed a network meta-analysis comparing Prasugrel to Ticagrelor in patients with acute coronary syndrome (ACS). Methods We included RCTs that compared Ticagrelor and Prasugrel to each other or to Clopidogrel. The primary endpoint was major adverse cardiovascular events (MACE). Secondary endpoints included all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, stent thrombosis and major or minor bleeding. Results Eleven RCTs with 49,966 patients (Clopidogrel=22,246, Prasugrel=15,139, Ticagrelor=12,581) were included. The mean follow-up was 7.15±6 months. There was no difference between Ticagrelor and Prasugrel in MACE (Hazard Ratio [HR] 0.91, 95% confidence interval [CI] 0.77-1.09, p=0.42), all-cause mortality (HR 0.90, 95%CI 0.68-1.18, p=0.75), cardiovascular mortality (HR 0.90, 95%CI 0.68-1.18, p=0.14), stroke (HR 1.21, 95%CI 0.79-1.85, p=0.32) and myocardial infarction (HR 1.09, 95%CI 0.93-1.29, p=1.07). Stent thrombosis was more frequent with Ticagrelor than with Prasugrel (HR 1.45, 95%CI 1.06-1.98, p=0.02). Conclusion In patients with acute coronary syndrome, Prasugrel and Ticagrelor in addition to Aspirin resulted in comparable outcomes, with the exception of stent thrombosis which was more frequent with in the Ticagrelor group.

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