The risk of gastrointestinal bleeding in patients taking third-generation P2Y12 inhibitors compared with clopidogrel: systematic review and meta-analysis.

Publication/Presentation Date

10-1-2025

Abstract

BACKGROUND: Dual antiplatelet therapy is an essential component in the management of acute coronary syndrome (ACS) but with a significant risk of bleeding. Newer third-generation P2Y12 inhibitors have proven to be more efficacious but have increased the risk of bleeding. This meta-analysis will study the difference in risk of gastrointestinal bleeding in clopidogrel vs. third-generation oral P2Y12 inhibitors.

METHODS: A literature search was done in two databases (PubMed/Medline and Cochrane Central). All studies meeting the inclusion criteria assessing the occurrence of gastrointestinal bleeding following the use of oral third-generation P2Y12 inhibitors or clopidogrel were systematically identified. A random-effects meta-analysis evaluated the two arms' risk ratios (RR).

RESULTS: A total of 16 studies were included in our analysis, 11 of which compared ticagrelor to clopidogrel and 5 of which compared prasugrel to clopidogrel. The combined risk for both third-generation P2Y12 inhibitors, Ticagrelor and Prasugrel, was as follows [RR: 1.31 (1.15-1.49);

CONCLUSION: Oral third-generation P2Y12 inhibitors were associated with an increased occurrence of gastrointestinal bleeding compared to clopidogrel.

Volume

87

Issue

10

First Page

6694

Last Page

6701

ISSN

2049-0801

Disciplines

Medicine and Health Sciences

PubMedID

41181437

Department(s)

Fellows and Residents

Document Type

Article

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