Coronary Artery DiseaseMeta-Analysis of the Relative Efficacy and Safety of Oral P2Y12 Inhibitors in Patients With Acute Coronary Syndrome
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Methods
This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses.7 We performed a systematic search of PubMed, Embase, and the Cochrane Library and cross-referenced relevant articles using various combinations of keywords, such as “acute coronary syndrome,” “myocardial infarction,” “P2Y12 inhibitors,” “thienopyridines,” “clopidogrel,” “prasugrel,” and “ticagrelor,” for eligible published
Results
Nine RCTs that included 106,288 patients met our criteria for inclusion.4, 5, 12, 13, 14, 15, 16, 17, 18 The search flow diagram is shown in Supplementary Figure 1. The network of treatment comparisons is shown in Figure 1. The bias assessment for each RCT is shown in Supplementary Figure 2. All included studies are high-quality trials based on Cochrane Collaboration guidelines (Supplementary Figure 2).
Table 1 describes the characteristics of the individual trials. Those trials enrolled a broad
Discussion
In this study of 106,288 patients enrolled in 9 RCTs, we compared the relative efficacies and safeties of 3 commonly used oral P2Y12 inhibitors across a broad spectrum of patients with ACS using Bayesian network meta-analysis. This is the most comprehensive meta-analysis of RCTs and included the largest number of patients reported on this topic. We found that clopidogrel decreased the risks of MACEs and recurrent MI at the expense of an increased risk of major bleeding. However, overall, the
Disclosures
The authors have no conflicts of interest to disclose.
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