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      Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Acute Coronary Syndrome: A Comprehensive Meta-Analysis

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          Abstract

          Background

          Ticagrelor is currently recommended for patients with the acute coronary syndrome (ACS). However, recent studies have yielded controversial results.

          Objective

          To compare the clinical outcomes between ticagrelor and clopidogrel in patients with ACS.

          Methods

          Three electronic databases were queried until April 25, 2021. We defined major adverse cardiovascular events (MACEs) as the primary efficacy endpoint. The secondary efficacy endpoints included stroke, stent thrombosis, cardiovascular death, all-cause death, and myocardial infarction. The safety endpoints were (major and minor) bleeding. Odds ratios (ORs) and 95% CIs were calculated to represent the estimated effect sizes.

          Results

          A total of 270,937 patients with ACS from 10 clinical trials and 18 observational studies were included. No significant difference was detected in MACE (OR 0.81, 95% CI 0.60–1.08, p = 0.15, I 2 = 64.83%). However, ticagrelor introduced a higher risk of bleeding (1.46, 1.17–1.83, 0.00, 61.66%) and minor bleeding (1.71, 1.33–2.21, 0.00, 4.65%) in clinical trials. The results of secondary efficacy endpoints differed in the clinical trials and observational studies. Subgroup analysis demonstrated that ticagrelor showed better therapeutic effects in patients who underwent the percutaneous coronary intervention (PCI) (0.38, 0.23–0.63, 0.00, 0) than those intended for PCI (1.03, 0.76–1.38, 0.87, 64.26%). Meanwhile, ticagrelor showed different therapeutic effects on patients with ACS of different ethnicities and different countries.

          Conclusion

          This meta-analysis demonstrated that ticagrelor is not superior to clopidogrel in MACE but is associated with a higher risk of bleeding in patients with ACS. Different PCI strategies, ethnicities, and countries may be the factors that contribute to different therapeutic effects of ticagrelor.

          Systematic Review Registration

          This study is registered with PROSPERO (CRD42021251212).

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          Most cited references56

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          RoB 2: a revised tool for assessing risk of bias in randomised trials

          Jonathan A C Sterne, Jelena Savović, Matthew J L Page … (2022)
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            Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Cardiovasc Med
                Journal ID (iso-abbrev): Front Cardiovasc Med
                Journal ID (publisher-id): Front. Cardiovasc. Med.
                Title: Frontiers in Cardiovascular Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2297-055X
                Publication date (Electronic): 27 January 2022
                Publication date Collection: 2021
                Volume: 8
                Electronic Location Identifier: 818215
                Affiliations
                [1] 1Department of Clinical Laboratory, Jining Academy of Medical Sciences , Jining, China
                [2] 2Department of Clinical Laboratory, Jiaxiang Women and Children's Hospital , Jining, China
                [3] 3Department of Cardiology, Jining Academy of Medical Sciences , Jining, China
                Author notes

                Edited by: Diego Gallo, Politecnico di Torino, Italy

                Reviewed by: Kyeong Ho Yun, Wonkwang University, South Korea; Felice Gragnano, University of Campania Luigi Vanvitelli, Italy

                *Correspondence: Linping Li llp0522@ 123456163.com

                This article was submitted to Cardiovascular Therapeutics, a section of the journal Frontiers in Cardiovascular Medicine

                Article
                DOI: 10.3389/fcvm.2021.818215
                PMC ID: 8829718
                PubMed ID: 35155618
                SO-VID: ea381b39-e05a-4c1d-9278-005d567ccf97
                Copyright © Copyright © 2022 Sun, Cui and Li.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 19 November 2021
                Date accepted : 24 December 2021
                Page count
                Figures: 4, Tables: 4, Equations: 0, References: 56, Pages: 11, Words: 6640
                Categories
                Subject: Cardiovascular Medicine
                Subject: Systematic Review

                Keywords: ticagrelor,clopidogrel,acute coronary syndrome,percutaneous coronary intervention,meta-analysis
                Data availability:
                Keywords: ticagrelor, clopidogrel, acute coronary syndrome, percutaneous coronary intervention, meta-analysis

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