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Ischaemic and bleeding complications with new, compared to standard, ADP-antagonist regimens in acute coronary syndromes: a meta-analysis of randomized trials

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dc.contributor.author Navarese, Eliano Pio
dc.contributor.author Verdoia, M.
dc.contributor.author Schaffer, A.
dc.contributor.author Suriano, P.
dc.contributor.author Koziński, Marek
dc.contributor.author Castriota, Fausto
dc.contributor.author De Servi, Stefano
dc.contributor.author Kubica, Jacek
dc.contributor.author De Luca, G.
dc.date.accessioned 2012-12-19T16:21:13Z
dc.date.available 2012-12-19T16:21:13Z
dc.date.issued 2012-12-19
dc.identifier.uri http://repozytorium.umk.pl/handle/item/264
dc.description.abstract Background: Platelets play a pivotal role in the pathogenesis of acute coronary syndromes (ACS) and their inhibition remains a mainstay therapy in this setting. We aimed to perform a meta-analysis of randomized trials to evaluate the benefits of new oral antiplatelet regimens to block platelet ADPreceptors compared to standard-dose clopidogrel (300 mg loading dose followed by 75 mg/daily). Methods: We obtained results from all randomized trials enrolling patients with ACS. Primary endpoint was mortality. Secondary endpoints were myocardial infarction and definite in-stent thrombosis. Safety endpoint was the risk of major bleeding complications. We prespecified subanalyses according to new antiplatelet drugs (prasugrel/ticagrelor), high-dose clopidogrel (600 mg) and patients undergoing percutaneous coronary intervention. Results: A total of seven randomized trials were finally included in the meta-analysis (n = 58 591). We observed a significant reduction in mortality (2.9% vs. 3.4%, OR= 0.87, 95% CI 0.79–0.95, P = 0.002), recurrent myocardial infarction (4.2% vs. 5.2%, OR= 0.80, 95% CI 0.74–0.87, P < 0.0001), definite in-stent thrombosis (0.9% vs. 1.7%, OR= 0.52, 95% CI 0.43–0.63, P < 0.0001). The benefits in mortality and reinfarction were driven by the treatment with prasugrel or ticagrelor, without a significant difference in terms of major bleeding complications as compared to standarddose clopidogrel (5% vs. 4.7%, OR= 1.06 95% CI 0.96–1.17, P = 0.25). Conclusions: This meta-analysis showed that new oral antiplatelet regimens are associated with a significant reduction in mortality, reinfarction and in-stent thrombosis in ACS patients without an overall increase of major bleeding when treated with new antiplatelet drugs.
dc.language.iso eng
dc.rights info:eu-repo/semantics/openAccess
dc.subject Ischaemic
dc.subject bleeding complications
dc.subject ADP-antagonist
dc.subject acute coronary syndromes
dc.title Ischaemic and bleeding complications with new, compared to standard, ADP-antagonist regimens in acute coronary syndromes: a meta-analysis of randomized trials
dc.type info:eu-repo/semantics/article


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