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2017 ; 12
(5
): e0177872
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gab.com Text
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English Wikipedia
The clinical efficacy and safety evaluation of ticagrelor for acute coronary
syndrome in general ACS patients and diabetic patients: A systematic review and
meta-analysis
#MMPMID28545073
Tan Q
; Jiang X
; Huang S
; Zhang T
; Chen L
; Xie S
; Mo E
; Xu J
; Cai S
PLoS One
2017[]; 12
(5
): e0177872
PMID28545073
show ga
OBJECTIVE: In this study, a systematic evaluation was conducted to estimate the
efficacy and safety of ticagrelor for treating acute coronary syndrome (ACS) in
general ACS patients and a diabetes mellitus (DM) group. METHODS: A search of
PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CNKI
databases was conducted to analyze relevant randomized controlled trails (RCTs)
of ticagrelor treating ACS during 2007 to 2015. Article screening, quality
accessing and data extracting was independently undertaken by two reviewers. A
meta-analysis was performed to clarify the efficacy and safety of ticagrelor in
general ACS patients, and a meta-regression analysis was taken to demonstrate the
efficacy and safety of ticagrelor in DM patients compared with general ACS
patients. RESULT: Twenty-two studies with 35004 participants were included. The
meta-analysis result implicated that ticagrelor could: 1) reduce the incidence of
the composite endpoint [OR = 0.83, 95%CI (0.77, 0.90), P<0.00001] and the
incidence of myocardial infarction [OR = 0.81, 95%CI (0.74, 0.89), P = 0.0001];
2) not statistically reduce the incidence of cardiovascular death, the incidence
of stroke and the incidence of bleeding events; 3) increase the incidence of
dyspnea [OR = 1.90, 95%CI (1.73, 2.08), P<0.00001] compared with clopidogrel.
Meanwhile, compared with prasugrel, ticagrelor could 1) reduce the platelet
reactivity of patients at maintenance dose [MD = -44.59, 95%CI (-59.16, -30.02),
P<0.00001]; 2) not statistically reduce the incidence of cardiovascular death,
the platelet reactivity of patients 6 hours or 8 hours after administration, or
the incidence of bleeding events; 3) induce the incidence of dyspnea [OR = 13.99,
95%CI (2.58, 75.92), P = 0.002]. Furthermore, the result of meta-regression
analysis implicated that there was a positive correlation between DM patients and
the platelet reactivity of patients 6 hours and 8 hours after administration, but
there was no obvious correlation between DM patients and general ACS patients in
other endpoints. CONCLUSION: Ticagrelor could reduce the incidence of composite
endpoint of cardiovascular death, myocardial infarction and stroke as well as
platelet reactivity in DM patients with ACS, while not increasing the risk of
bleeding. Because there are differences in platelet reactivity between DM
patients and general ACS patients, we suggest that caution is needed when using
ticagrelor in clinical applications.