Meta-Analysis of Randomized Controlled Trials Comparing Risk of Major Adverse Cardiac Events and Bleeding in Patients With Prasugrel Versus Clopidogrel
The use of prasugrel in patients with coronary artery disease (CAD) has been associated with decreased major adverse cardiac events (MACEs) compared with clopidogrel but with an increased risk of bleeding. However, it remains unclear if the risks of bleeding outweigh those of MACEs in patients on pr...
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| Veröffentlicht in: | The American journal of cardiology 2015-08, Vol.116 (3), p.384-392 |
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| creator | Chen, Hai-Bin, MD Zhang, Xin-Lu, MD Liang, Hong-Bin, MD Liu, Xue-Wei, MD Zhang, Xin-Yu, MD Huang, Bao-Yi, MD Xiu, Jiancheng, MD, PhD |
| description | The use of prasugrel in patients with coronary artery disease (CAD) has been associated with decreased major adverse cardiac events (MACEs) compared with clopidogrel but with an increased risk of bleeding. However, it remains unclear if the risks of bleeding outweigh those of MACEs in patients on prasugrel treatment. We systematically reviewed randomized controlled trials comparing prasugrel with clopidogrel in patients with CAD. We performed a literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trial databases from inception to November 25, 2014, and reviewed the reference lists of retrieved articles. A comparative estimate was made for the combined rates of MACEs and bleeding from the same trials in the framework of this meta-analysis and expressed as odds ratios (ORs) and 95% confidence intervals (CIs) in both random- and fixed-effects models. Nine studies involving 25,214 patients were included in our meta-analysis. In both the random- and fixed-effects models, the risks of MACEs outweighed those of major bleeding (OR 7.48, 95% CI 3.75 to 14.94, p |
| doi_str_mv | 10.1016/j.amjcard.2015.04.054 |
| format | Article |
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However, it remains unclear if the risks of bleeding outweigh those of MACEs in patients on prasugrel treatment. We systematically reviewed randomized controlled trials comparing prasugrel with clopidogrel in patients with CAD. We performed a literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trial databases from inception to November 25, 2014, and reviewed the reference lists of retrieved articles. A comparative estimate was made for the combined rates of MACEs and bleeding from the same trials in the framework of this meta-analysis and expressed as odds ratios (ORs) and 95% confidence intervals (CIs) in both random- and fixed-effects models. Nine studies involving 25,214 patients were included in our meta-analysis. In both the random- and fixed-effects models, the risks of MACEs outweighed those of major bleeding (OR 7.48, 95% CI 3.75 to 14.94, p <0.0001, random effects) and of minor bleeding (OR 3.77, 95% CI 1.73 to 8.22, p = 0.009, random effects). Results were corroborated in a standard-dose clopidogrel subgroup analysis (OR 7.46, 95% CI 3.54 to 15.68, p <0.0001, and OR 6.44, 95% CI 2.80 to 14.80, p <0.0001, random effects, respectively). In conclusion, despite the increased risk of bleeding associated with prasugrel treatment compared with clopidogrel, the risk of MACEs far outweighed the risk of bleeding.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2015.04.054</identifier><identifier>PMID: 26051379</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bias ; Cardiology ; Cardiovascular ; Clinical trials ; Collaboration ; Confidence intervals ; Coronary Artery Disease - drug therapy ; Global Health ; Heart attacks ; Hemorrhage - chemically induced ; Hemorrhage - epidemiology ; Humans ; Incidence ; Piperazines - adverse effects ; Piperazines - therapeutic use ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Prasugrel Hydrochloride ; Purinergic P2Y Receptor Antagonists - adverse effects ; Purinergic P2Y Receptor Antagonists - therapeutic use ; Randomized Controlled Trials as Topic ; Regression analysis ; Risk Factors ; Studies ; Thiophenes - adverse effects ; Thiophenes - therapeutic use ; Ticlopidine - adverse effects ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use</subject><ispartof>The American journal of cardiology, 2015-08, Vol.116 (3), p.384-392</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 1, 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-fe5b04355fcfa0655f8043d57dd3e1e08ea79c869e5826427c283ae1b9466b413</citedby><cites>FETCH-LOGICAL-c518t-fe5b04355fcfa0655f8043d57dd3e1e08ea79c869e5826427c283ae1b9466b413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914915012527$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26051379$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Hai-Bin, MD</creatorcontrib><creatorcontrib>Zhang, Xin-Lu, MD</creatorcontrib><creatorcontrib>Liang, Hong-Bin, MD</creatorcontrib><creatorcontrib>Liu, Xue-Wei, MD</creatorcontrib><creatorcontrib>Zhang, Xin-Yu, MD</creatorcontrib><creatorcontrib>Huang, Bao-Yi, MD</creatorcontrib><creatorcontrib>Xiu, Jiancheng, MD, PhD</creatorcontrib><title>Meta-Analysis of Randomized Controlled Trials Comparing Risk of Major Adverse Cardiac Events and Bleeding in Patients With Prasugrel Versus Clopidogrel</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The use of prasugrel in patients with coronary artery disease (CAD) has been associated with decreased major adverse cardiac events (MACEs) compared with clopidogrel but with an increased risk of bleeding. However, it remains unclear if the risks of bleeding outweigh those of MACEs in patients on prasugrel treatment. We systematically reviewed randomized controlled trials comparing prasugrel with clopidogrel in patients with CAD. We performed a literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trial databases from inception to November 25, 2014, and reviewed the reference lists of retrieved articles. A comparative estimate was made for the combined rates of MACEs and bleeding from the same trials in the framework of this meta-analysis and expressed as odds ratios (ORs) and 95% confidence intervals (CIs) in both random- and fixed-effects models. Nine studies involving 25,214 patients were included in our meta-analysis. In both the random- and fixed-effects models, the risks of MACEs outweighed those of major bleeding (OR 7.48, 95% CI 3.75 to 14.94, p <0.0001, random effects) and of minor bleeding (OR 3.77, 95% CI 1.73 to 8.22, p = 0.009, random effects). Results were corroborated in a standard-dose clopidogrel subgroup analysis (OR 7.46, 95% CI 3.54 to 15.68, p <0.0001, and OR 6.44, 95% CI 2.80 to 14.80, p <0.0001, random effects, respectively). In conclusion, despite the increased risk of bleeding associated with prasugrel treatment compared with clopidogrel, the risk of MACEs far outweighed the risk of bleeding.</description><subject>Bias</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Clinical trials</subject><subject>Collaboration</subject><subject>Confidence intervals</subject><subject>Coronary Artery Disease - drug therapy</subject><subject>Global Health</subject><subject>Heart attacks</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - epidemiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Piperazines - adverse effects</subject><subject>Piperazines - therapeutic use</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Prasugrel Hydrochloride</subject><subject>Purinergic P2Y Receptor Antagonists - adverse effects</subject><subject>Purinergic P2Y Receptor Antagonists - therapeutic use</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Studies</subject><subject>Thiophenes - adverse effects</subject><subject>Thiophenes - therapeutic use</subject><subject>Ticlopidine - adverse effects</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ticlopidine - therapeutic use</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFUk1v1DAQtRCILoWfALLEhUuC7cROcgEtq_IhtaIqBY6W154Up068tZOVtn-kfxenu4DUC6fxjN-8sd8bhF5SklNCxdsuV32nVTA5I5TnpMwJLx-hBa2rJqMNLR6jBSGEZQ0tmyP0LMYupZRy8RQdMUE4Lapmge7OYFTZclBuF23EvsUXajC-t7dg8MoPY_DOpeNlsMrFVOk3KtjhCl_YeD3Dz1TnA16aLYQIeJUeZJXGJ1sYxogTFf7gAMzcYQd8rkZ7f_HTjr_weVBxugrg8I_UPCV25zfW-Ln0HD1p00B4cYjH6PvHk8vV5-z066cvq-Vppjmtx6wFviZlwXmrW0VEinVKDa-MKYACqUFVja5FA7xmomSVZnWhgK6bUoh1SYtj9GbPuwn-ZoI4yt5GDc6pAfwUJRUNr3gluEjQ1w-gnZ9CUu4eVdYiacsSiu9ROvgYA7RyE2yvwk5SImfnZCcPzsnZOUlKmZxLfa8O7NO6B_O3649VCfB-D4Akx9ZCkFEnMXUSN4AepfH2vyPePWDQzg5WK3cNO4j_fiMjk0R-m9dn3h7KCWWcVcVvw5PB-w</recordid><startdate>20150801</startdate><enddate>20150801</enddate><creator>Chen, Hai-Bin, MD</creator><creator>Zhang, Xin-Lu, MD</creator><creator>Liang, Hong-Bin, MD</creator><creator>Liu, Xue-Wei, MD</creator><creator>Zhang, Xin-Yu, MD</creator><creator>Huang, Bao-Yi, MD</creator><creator>Xiu, Jiancheng, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20150801</creationdate><title>Meta-Analysis of Randomized Controlled Trials Comparing Risk of Major Adverse Cardiac Events and Bleeding in Patients With Prasugrel Versus Clopidogrel</title><author>Chen, Hai-Bin, MD ; Zhang, Xin-Lu, MD ; Liang, Hong-Bin, MD ; Liu, Xue-Wei, MD ; Zhang, Xin-Yu, MD ; Huang, Bao-Yi, MD ; Xiu, Jiancheng, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c518t-fe5b04355fcfa0655f8043d57dd3e1e08ea79c869e5826427c283ae1b9466b413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Bias</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Clinical trials</topic><topic>Collaboration</topic><topic>Confidence intervals</topic><topic>Coronary Artery Disease - drug therapy</topic><topic>Global Health</topic><topic>Heart attacks</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - epidemiology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Piperazines - adverse effects</topic><topic>Piperazines - therapeutic use</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Prasugrel Hydrochloride</topic><topic>Purinergic P2Y Receptor Antagonists - adverse effects</topic><topic>Purinergic P2Y Receptor Antagonists - therapeutic use</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Studies</topic><topic>Thiophenes - adverse effects</topic><topic>Thiophenes - therapeutic use</topic><topic>Ticlopidine - adverse effects</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ticlopidine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Hai-Bin, MD</creatorcontrib><creatorcontrib>Zhang, Xin-Lu, MD</creatorcontrib><creatorcontrib>Liang, Hong-Bin, MD</creatorcontrib><creatorcontrib>Liu, Xue-Wei, MD</creatorcontrib><creatorcontrib>Zhang, Xin-Yu, MD</creatorcontrib><creatorcontrib>Huang, Bao-Yi, MD</creatorcontrib><creatorcontrib>Xiu, Jiancheng, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Hai-Bin, MD</au><au>Zhang, Xin-Lu, MD</au><au>Liang, Hong-Bin, MD</au><au>Liu, Xue-Wei, MD</au><au>Zhang, Xin-Yu, MD</au><au>Huang, Bao-Yi, MD</au><au>Xiu, Jiancheng, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-Analysis of Randomized Controlled Trials Comparing Risk of Major Adverse Cardiac Events and Bleeding in Patients With Prasugrel Versus Clopidogrel</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2015-08-01</date><risdate>2015</risdate><volume>116</volume><issue>3</issue><spage>384</spage><epage>392</epage><pages>384-392</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>The use of prasugrel in patients with coronary artery disease (CAD) has been associated with decreased major adverse cardiac events (MACEs) compared with clopidogrel but with an increased risk of bleeding. However, it remains unclear if the risks of bleeding outweigh those of MACEs in patients on prasugrel treatment. We systematically reviewed randomized controlled trials comparing prasugrel with clopidogrel in patients with CAD. We performed a literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trial databases from inception to November 25, 2014, and reviewed the reference lists of retrieved articles. A comparative estimate was made for the combined rates of MACEs and bleeding from the same trials in the framework of this meta-analysis and expressed as odds ratios (ORs) and 95% confidence intervals (CIs) in both random- and fixed-effects models. Nine studies involving 25,214 patients were included in our meta-analysis. In both the random- and fixed-effects models, the risks of MACEs outweighed those of major bleeding (OR 7.48, 95% CI 3.75 to 14.94, p <0.0001, random effects) and of minor bleeding (OR 3.77, 95% CI 1.73 to 8.22, p = 0.009, random effects). Results were corroborated in a standard-dose clopidogrel subgroup analysis (OR 7.46, 95% CI 3.54 to 15.68, p <0.0001, and OR 6.44, 95% CI 2.80 to 14.80, p <0.0001, random effects, respectively). In conclusion, despite the increased risk of bleeding associated with prasugrel treatment compared with clopidogrel, the risk of MACEs far outweighed the risk of bleeding.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26051379</pmid><doi>10.1016/j.amjcard.2015.04.054</doi><tpages>9</tpages></addata></record> |
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| subjects | Bias Cardiology Cardiovascular Clinical trials Collaboration Confidence intervals Coronary Artery Disease - drug therapy Global Health Heart attacks Hemorrhage - chemically induced Hemorrhage - epidemiology Humans Incidence Piperazines - adverse effects Piperazines - therapeutic use Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Prasugrel Hydrochloride Purinergic P2Y Receptor Antagonists - adverse effects Purinergic P2Y Receptor Antagonists - therapeutic use Randomized Controlled Trials as Topic Regression analysis Risk Factors Studies Thiophenes - adverse effects Thiophenes - therapeutic use Ticlopidine - adverse effects Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use |
| title | Meta-Analysis of Randomized Controlled Trials Comparing Risk of Major Adverse Cardiac Events and Bleeding in Patients With Prasugrel Versus Clopidogrel |
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