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Erschienen in: Journal of Thrombosis and Thrombolysis 3/2018

22.06.2018

Ticagrelor versus clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis of randomized clinical trials

verfasst von: Babikir Kheiri, Mohammed Osman, Ahmed Abdalla, Tarek Haykal, Mahmoud Barbarawi, Yazan Zayed, Michael Hicks, Sahar Ahmed, Ghassan Bachuwa, Mustafa Hassan, Deepak L. Bhatt

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 3/2018

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Abstract

Dual antiplatelet therapy with aspirin and clopidogrel are recommended as adjuncts to fibrinolytic-treated patients with ST-elevation myocardial infarction (STEMI). However, the role of switching to ticagrelor within 24 h of fibrinolytics compared with clopidogrel continuation in this setting is uncertain. Hence, we conducted a comprehensive search of electronic databases for all randomized clinical trials (RCTs) that evaluated the safety and efficacy of ticagrelor versus clopidogrel after fibrinolytic therapy in patients with STEMI. A random-effects model was used to calculate the risk ratios (RRs) and 95% confidence intervals (CIs). A total of 5 RCTs that evaluated the efficacy of ticagrelor post-fibrinolysis were identified. We included 3 RCTs with 3999 total patients for our meta-analysis. The results showed similar short-term clinical outcomes between ticagrelor and clopidogrel with regard to rates of Bleeding Academic Research Consortium (BARC) type ≥ 2 bleeding (RR 0.94; 95% CI 0.56–1.60; P = 0.83), major adverse cardiovascular events (RR 0.87; 95% CI 0.49–1.52; P = 0.62), mortality (RR 0.92; 95% CI 0.53–1.59; P = 0.77), myocardial infarction (RR 0.76; 95% CI 0.43–1.36; P = 0.36), and stroke (RR 0.93; 95% CI 0.50–1.73; P = 0.82). Our results demonstrate that in STEMI patients treated with fibrinolytic therapy, switching to ticagrelor was associated with similar bleeding and ischemic outcomes compared with clopidogrel continuation.
Literatur
1.
Zurück zum Zitat Ibanez B, James S, Agewall S et al (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society. Eur Heart J 39:119–177CrossRefPubMed Ibanez B, James S, Agewall S et al (2018) 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society. Eur Heart J 39:119–177CrossRefPubMed
2.
Zurück zum Zitat O’Gara PT, Kushner FG, Ascheim DD et al (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127:e362–e425CrossRefPubMed O’Gara PT, Kushner FG, Ascheim DD et al (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127:e362–e425CrossRefPubMed
3.
Zurück zum Zitat Bates ER (2014) Evolution from fibrinolytic therapy to a fibrinolytic strategy for patients with ST-segment-elevation myocardial infarction. Circulation 130:1133–1135CrossRefPubMed Bates ER (2014) Evolution from fibrinolytic therapy to a fibrinolytic strategy for patients with ST-segment-elevation myocardial infarction. Circulation 130:1133–1135CrossRefPubMed
4.
Zurück zum Zitat Armstrong PW, Collen D (2001) Fibrinolysis for acute myocardial infarction: current status and new horizons for pharmacological reperfusion, part 2. Circulation 103:2987–2992CrossRefPubMed Armstrong PW, Collen D (2001) Fibrinolysis for acute myocardial infarction: current status and new horizons for pharmacological reperfusion, part 2. Circulation 103:2987–2992CrossRefPubMed
5.
Zurück zum Zitat Diego A, De Prado AP, Cuellas C et al (2012) P2Y12 platelet reactivity after thrombolytic therapy for ST-segment elevation myocardial infarction. Thromb Res 130:e31–e36CrossRefPubMed Diego A, De Prado AP, Cuellas C et al (2012) P2Y12 platelet reactivity after thrombolytic therapy for ST-segment elevation myocardial infarction. Thromb Res 130:e31–e36CrossRefPubMed
6.
Zurück zum Zitat Moser M, Nordt T, Peter K et al (1999) Platelet function during and after thrombolytic therapy for acute myocardial infarction with reteplase, alteplase, or streptokinase. Circulation 100:1858–1864CrossRefPubMed Moser M, Nordt T, Peter K et al (1999) Platelet function during and after thrombolytic therapy for acute myocardial infarction with reteplase, alteplase, or streptokinase. Circulation 100:1858–1864CrossRefPubMed
7.
Zurück zum Zitat Gurbel PA, Serebruany VL, Shustov AR et al (1998) Effects of reteplase and alteplase on platelet aggregation and major receptor expression during the first 24 hours of acute myocardial infarction treatment. GUSTO-III Investigators. Global Use of Strategies to Open Occluded Coronary Arteries. J Am Coll Cardiol 31:1466–1473CrossRefPubMed Gurbel PA, Serebruany VL, Shustov AR et al (1998) Effects of reteplase and alteplase on platelet aggregation and major receptor expression during the first 24 hours of acute myocardial infarction treatment. GUSTO-III Investigators. Global Use of Strategies to Open Occluded Coronary Arteries. J Am Coll Cardiol 31:1466–1473CrossRefPubMed
8.
Zurück zum Zitat Husted S, Emanuelsson H, Heptinstall S et al (2006) Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur Heart J 27:1038–1047CrossRefPubMed Husted S, Emanuelsson H, Heptinstall S et al (2006) Pharmacodynamics, pharmacokinetics, and safety of the oral reversible P2Y12 antagonist AZD6140 with aspirin in patients with atherosclerosis: a double-blind comparison to clopidogrel with aspirin. Eur Heart J 27:1038–1047CrossRefPubMed
9.
Zurück zum Zitat Wallentin L, Becker R, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057CrossRefPubMed Wallentin L, Becker R, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057CrossRefPubMed
10.
Zurück zum Zitat Dehghani P, Lavoie A, Lavi S et al (2017) Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI. Am Heart J 192:105–112CrossRefPubMed Dehghani P, Lavoie A, Lavi S et al (2017) Effects of ticagrelor versus clopidogrel on platelet function in fibrinolytic-treated STEMI patients undergoing early PCI. Am Heart J 192:105–112CrossRefPubMed
11.
Zurück zum Zitat Alexopoulos D, Perperis A, Koniari I et al (2015) Ticagrelor versus high dose clopidogrel in ST-segment elevation myocardial infarction patients with high platelet reactivity post fibrinolysis. J Thromb Thrombolysis 40:261–267CrossRefPubMed Alexopoulos D, Perperis A, Koniari I et al (2015) Ticagrelor versus high dose clopidogrel in ST-segment elevation myocardial infarction patients with high platelet reactivity post fibrinolysis. J Thromb Thrombolysis 40:261–267CrossRefPubMed
12.
Zurück zum Zitat Yang A, Pon Q, Lavoie A et al (2018) Long-term pharmacodynamic effects of ticagrelor versus clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI. J Thromb Thrombolysis 45:225–233CrossRefPubMed Yang A, Pon Q, Lavoie A et al (2018) Long-term pharmacodynamic effects of ticagrelor versus clopidogrel in fibrinolytic-treated STEMI patients undergoing early PCI. J Thromb Thrombolysis 45:225–233CrossRefPubMed
13.
Zurück zum Zitat Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1–9CrossRefPubMedPubMedCentral Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1–9CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Berwanger O, Nicolau JC, Carvalho AC et al (2018) Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a randomized clinical trial. JAMA Cardiol 3:391–399CrossRefPubMed Berwanger O, Nicolau JC, Carvalho AC et al (2018) Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a randomized clinical trial. JAMA Cardiol 3:391–399CrossRefPubMed
15.
Zurück zum Zitat Guimarães L, Généreux P, Silveira D et al (2017) P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: analysis from the SAMPA randomized trial. Int J Cardiol 230:204–208CrossRefPubMed Guimarães L, Généreux P, Silveira D et al (2017) P2Y12 receptor inhibition with prasugrel and ticagrelor in STEMI patients after fibrinolytic therapy: analysis from the SAMPA randomized trial. Int J Cardiol 230:204–208CrossRefPubMed
16.
Zurück zum Zitat Chen ZM, Jiang LX, Chen YP et al (2005) Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366:1607–1621CrossRefPubMed Chen ZM, Jiang LX, Chen YP et al (2005) Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366:1607–1621CrossRefPubMed
17.
Zurück zum Zitat Sabatine M, Cannon C, Gibson C et al (2005) Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 352:1179–1189CrossRefPubMed Sabatine M, Cannon C, Gibson C et al (2005) Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 352:1179–1189CrossRefPubMed
18.
Zurück zum Zitat Angiolillo DJ, Ferreiro JL, Price MJ et al (2013) Platelet function and genetic testing. J Am Coll Cardiol 62:S21–S31CrossRefPubMed Angiolillo DJ, Ferreiro JL, Price MJ et al (2013) Platelet function and genetic testing. J Am Coll Cardiol 62:S21–S31CrossRefPubMed
Metadaten
Titel
Ticagrelor versus clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis of randomized clinical trials
verfasst von
Babikir Kheiri
Mohammed Osman
Ahmed Abdalla
Tarek Haykal
Mahmoud Barbarawi
Yazan Zayed
Michael Hicks
Sahar Ahmed
Ghassan Bachuwa
Mustafa Hassan
Deepak L. Bhatt
Publikationsdatum
22.06.2018
Verlag
Springer US
Erschienen in
Journal of Thrombosis and Thrombolysis / Ausgabe 3/2018
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-018-1706-2

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