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- Title:
Ticagrelor-based antiplatelet regimens in patients with atherosclerotic artery disease-A meta-analysis of randomized clinical trials.
- Document type:
- Article; Journal Article
- Author(s):
- Cassese, Salvatore; Ndrepepa, Gjin; Byrne, Robert A; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Fusaro, Massimiliano; Alfonso, Fernando; Kastrati, Adnan
- Abstract:
- BACKGROUND: Randomized trials did not consistently support superiority of ticagrelor, as monotherapy or in combination with aspirin, in terms of efficacy or safety, in patients with atherosclerotic artery disease. METHODS: Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and scientific session abstracts were searched for trials of patients with coronary or peripheral artery disease (with >1,000 participants and a follow-up ≥3 months) randomly assigned to ticagrelor-based or conventional antiplatelet therapies. Trial-level hazard ratios (HRs) were pooled using a fixed- or random-effect model (in case of significant heterogeneity) with the inverse variance weighting. The primary outcome was all-cause mortality. Other outcomes were myocardial infarction (MI), stroke, and major bleeding. RESULTS: Overall 77,489 patients received either ticagrelor-based (n = 38,721) or conventional antiplatelet regimens (n = 38,768) in 6 trials. The primary outcome occurred in 4.5% of patients treated with experimental therapy and 4.9% of patients treated with control therapy (HR = 0.91, 95% CI 0.81-1.01; P = .07). Overall, patients treated with ticagrelor-based versus conventional antiplatelet regimens showed no significant difference in terms of all-cause death, MI, stroke, or major bleeding after 20 months. However, in trials of patients with coronary artery disease as primary diagnosis, the risk for all-cause death (HR = 0.84 [0.77-0.91], P < .001) and MI (HR = 0.87 [0.80-0.94], P = .007) was significantly reduced by experimental therapy. CONCLUSIONS: In patients with atherosclerotic artery disease, the benefit of ticagrelor-based therapies was confined to patients treated for coronary artery disease. The drug significantly reduced the risk for all-cause death and MI without excess risk of bleeding in these patients. In consideration of limitations of subgroup analyses, these results need further validation.
- Journal title abbreviation:
- Am Heart J
- Year:
- 2020
- Journal volume:
- 219
- Pages contribution:
- 109-116
- Fulltext / DOI:
- doi:10.1016/j.ahj.2019.08.020
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/31756624
- Print-ISSN:
- 0002-8703
- TUM Institution:
- I. Medizinische Klinik und Poliklinik (Kardiologie); Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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