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

dc.contributor.authorNavarese, Eliano Pio
dc.contributor.authorVerdoia, M.
dc.contributor.authorSchaffer, A.
dc.contributor.authorSuriano, P.
dc.contributor.authorKoziński, Marek
dc.contributor.authorCastriota, Fausto
dc.contributor.authorDe Servi, Stefano
dc.contributor.authorKubica, Jacek
dc.contributor.authorDe Luca, G.
dc.date.accessioned2012-12-19T16:21:13Z
dc.date.available2012-12-19T16:21:13Z
dc.date.issued2012-12-19
dc.description.abstractBackground: 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.pl
dc.identifier.urihttp://repozytorium.umk.pl/handle/item/264
dc.language.isoengpl
dc.rightsinfo:eu-repo/semantics/openAccessen
dc.subjectIschaemicpl
dc.subjectbleeding complicationspl
dc.subjectADP-antagonistpl
dc.subjectacute coronary syndromespl
dc.titleIschaemic and bleeding complications with new, compared to standard, ADP-antagonist regimens in acute coronary syndromes: a meta-analysis of randomized trialspl
dc.typeinfo:eu-repo/semantics/articlepl

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