Optimal Timing of P2Y12 Inhibitor Loading in Patients Undergoing PCI: A Meta-Analysis.
Acute Coronary Syndrome
/ epidemiology
Clinical Protocols
Clinical Trials as Topic
Clopidogrel
/ therapeutic use
Humans
Percutaneous Coronary Intervention
Postoperative Complications
/ epidemiology
Prasugrel Hydrochloride
/ therapeutic use
Purinergic P2Y Receptor Antagonists
/ therapeutic use
Risk
Survival Analysis
Ticagrelor
/ therapeutic use
Time Factors
Journal
Thrombosis and haemostasis
ISSN: 2567-689X
Titre abrégé: Thromb Haemost
Pays: Germany
ID NLM: 7608063
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
pubmed:
29
3
2019
medline:
18
12
2019
entrez:
29
3
2019
Statut:
ppublish
Résumé
The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI). This is a systematic review and meta-analysis. Randomized controlled trials and non-randomized studies were included. Outcomes evaluated were combined major adverse cardiovascular events (MACEs), myocardial infarction (MI), target vessel revascularization, death and bleeding complications. Summary estimates of the relative risks with therapy were calculated. Twenty-three studies met the selection criteria and included 60,907 patients. Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction (RRR) of MACE (95% confidence interval [CI] = 0.68-0.89; Early clopidogrel loading is associated with a better efficacy and similar safety, whereas timing of ticagrelor or prasugrel loading had no effects on ischaemic events.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI).
METHODS
METHODS
This is a systematic review and meta-analysis. Randomized controlled trials and non-randomized studies were included. Outcomes evaluated were combined major adverse cardiovascular events (MACEs), myocardial infarction (MI), target vessel revascularization, death and bleeding complications. Summary estimates of the relative risks with therapy were calculated.
RESULTS
RESULTS
Twenty-three studies met the selection criteria and included 60,907 patients. Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction (RRR) of MACE (95% confidence interval [CI] = 0.68-0.89;
CONCLUSION
CONCLUSIONS
Early clopidogrel loading is associated with a better efficacy and similar safety, whereas timing of ticagrelor or prasugrel loading had no effects on ischaemic events.
Identifiants
pubmed: 30919382
doi: 10.1055/s-0039-1683421
doi:
Substances chimiques
Purinergic P2Y Receptor Antagonists
0
Clopidogrel
A74586SNO7
Prasugrel Hydrochloride
G89JQ59I13
Ticagrelor
GLH0314RVC
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1000-1020Informations de copyright
Georg Thieme Verlag KG Stuttgart · New York.
Déclaration de conflit d'intérêts
None declared.