1. Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: Systematic review and meta-analysis.
- Author
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Misumida N, Aoi S, Kim SM, Ziada KM, and Abdel-Latif A
- Subjects
- Acute Coronary Syndrome blood, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome ethnology, Aged, Asian People, Blood Platelets metabolism, Clopidogrel adverse effects, Asia, Eastern epidemiology, Female, Hemorrhage chemically induced, Hemorrhage ethnology, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors adverse effects, Platelet Function Tests, Purinergic P2Y Receptor Antagonists adverse effects, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Ticagrelor adverse effects, Treatment Outcome, Acute Coronary Syndrome drug therapy, Blood Platelets drug effects, Clopidogrel therapeutic use, Platelet Aggregation Inhibitors therapeutic use, Purinergic P2Y Receptor Antagonists therapeutic use, Ticagrelor therapeutic use
- Abstract
Background: Bleeding complications are associated with unfavorable outcomes in patients with acute coronary syndrome (ACS). Compared to Whites, several studies demonstrated a higher risk of bleeding in Asians who present with acute myocardial infarction. To date, the efficacy and safety of ticagrelor in East Asian population have not been well established., Methods: We conducted a systematic review and meta-analysis of randomized controlled trials that compared ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome (ACS). We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov database., Results: Three randomized controlled trials, including a total of 1552 patients, met our inclusion criteria. Study countries included Japan, South Korea, and China. All studies defined primary efficacy endpoint and major bleeding events in accordance with the PLATO definition. Ticagrelor was associated with a numerically lower, albeit statistically nonsignificant, risk of primary efficacy endpoint defined as a composite of death from vascular causes, myocardial infarction, or stroke (odds ratio 0.84; 95% confidence interval 0.43-1.63; p = 0.60). Ticagrelor was associated with a significantly higher risk of PLATO-defined major bleeding compared to clopidogrel (odds ratio 1.52; 95% confidence interval 1.04-2.23; p = 0.03)., Conclusions: Our meta-analysis demonstrated that ticagrelor was associated with a higher risk of major bleeding compared to clopidogrel in East Asian patients with ACS. Further studies evaluating the role of ticagrelor in management of ACS in East Asian patients are warranted., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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