MedStar Authors catalog › Details for: A comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis.
A comparison of cangrelor, prasugrel, ticagrelor, and clopidogrel in patients undergoing percutaneous coronary intervention: A network meta-analysis. Journal: Cardiovascular revascularization medicine : including molecular interventions.Published: 2016ISSN: 1878-0938.UI/PMID: 28089137.Subject(s): Adenosine/ae [Adverse Effects] | *Adenosine/aa [Analogs & Derivatives] | Adenosine/tu [Therapeutic Use] | Adenosine Monophosphate/ae [Adverse Effects] | *Adenosine Monophosphate/aa [Analogs & Derivatives] | Adenosine Monophosphate/tu [Therapeutic Use] | Humans | Myocardial Infarction/dt [Drug Therapy] | Network Meta-Analysis | Percutaneous Coronary Intervention/mt [Methods] | *Percutaneous Coronary Intervention | Platelet Aggregation Inhibitors/ad [Administration & Dosage] | *Platelet Aggregation Inhibitors/tu [Therapeutic Use] | Prasugrel Hydrochloride/ae [Adverse Effects] | *Prasugrel Hydrochloride/tu [Therapeutic Use] | Purinergic P2Y Receptor Antagonists/ae [Adverse Effects] | *Purinergic P2Y Receptor Antagonists/tu [Therapeutic Use] | Ticlopidine/ae [Adverse Effects] | *Ticlopidine/aa [Analogs & Derivatives] | Ticlopidine/tu [Therapeutic Use] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1016/j.carrev.2016.10.005 (Click here) Abbreviated citation: Cardiovasc Revasc Med. , 2016 Oct 21.Local Holdings: Available in print through MWHC library: 2002 - present.Abstract: BACKGROUND: Newer P2Y12 inhibitors have more rapid onset of platelet inhibition compared with clopidogrel, especially the intravenous P2Y12 inhibitor cangrelor. Direct comparisons between cangrelor and oral P2Y12 inhibitors ticagrelor and prasugrel do not exist. Thus, we performed a network meta-analysis to directly and indirectly compare different P2Y12 inhibitors in patients undergoing percutaneous coronary intervention (PCI).Abstract: METHODS: MEDLINE/PubMed and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) that compared at least two P2Y12 inhibitors including cangrelor, clopidogrel, prasugrel, and ticagrelor. Network meta-analysis with a Bayesian approach was performed to directly and indirectly compare the effects of the aforementioned P2Y12 inhibitors on clinical outcomes. Odds ratios with credible intervals (OR [CrIs]) were generated with random-effects models to compare outcomes.Abstract: RESULTS: This analysis included 15 RCTs with 54,025 patients randomized to cangrelor (n=12,475), clopidogrel (n=26,903), prasugrel (n=7455), or ticagrelor (n=7192) at time of PCI. Patients had a mean age of 63+/-10, 74% were male, and 82% underwent PCI for acute coronary syndrome. No significant differences between cangrelor and clopidogrel were found with respect to cardiovascular death (OR 1.01 [CrI 0.23-4.39]), myocardial infarction (OR 0.94 [CrI 0.69-1.25]), major adverse cardiac events (OR 0.91 [CrI 0.69-1.18]), stent thrombosis (OR 0.66 [CrI 0.37-1.19]), or major bleeding (OR 1.52 [CrI 0.79-2.98]). Rank probability data suggested that ticagrelor and prasugrel were better than cangrelor for reducing ischemic events, though these differences were not significant.Abstract: CONCLUSION: Despite rapid platelet inhibition provided by cangrelor, newer oral P2Y12 inhibitors such as ticagrelor and prasugrel have comparable clinical outcomes.Abstract: Copyright (c) 2016 Elsevier Inc. All rights reserved.