Comparative Safety and Effectiveness of Loading Doses of P2Y12 Inhibitors in Patients Undergoing Elective PCI: a Network Meta-analysis
Document Type
Article
Publication Date
10-13-2021
Publication Title
Cardiovascular drugs and therapy
E-ISSN
1573-7241
Department(s)
Department of Medicine; Cardiology Division; Fellows and Residents
Keywords
Elective PCI, Loading dose, Network meta-analysis, P2Y12 inhibition, Percutaneous coronary intervention
Abstract
PURPOSE: Effective platelet inhibition prior to elective percutaneous coronary intervention (PCI) reduces the risk of ischemic complications. Newer P2Y12 inhibitors are preferred agents over clopidogrel for patients presenting with the acute coronary syndrome. However, the comparative efficacy and safety of them over clopidogrel in elective PCI is unclear. We performed a network meta-analysis to compare the safety and efficacy of loading strategies of P2Y12 inhibitors in patients undergoing elective PCI. METHODS: We conducted a systematic review of randomized controlled trials (RCT) up to June 2021 to compare the safety and effectiveness of different loading strategies of P2Y12 inhibitors before elective PCI. The endpoints of interest were overall mortality, rates of myocardial infarction (MI), stroke, revascularization, and major bleeding. Random effects model using the frequentist approach was used to perform a network meta-analysis using R software. RESULTS: Five trials with a total of 5194 patients were included in our analysis. For ischemic outcomes, including MI, stroke, and revascularization, prasugrel had the most favorable trend. However, clopidogrel had the highest probability of being most effective for major bleeding and all-cause mortality. None of these trends was statistically significant due to lack of power for each outcome. CONCLUSION: Although prasugrel and ticagrelor are known as more potent antiplatelet agents, their effects in preventing MI and stroke are marginal and do not translate into improved overall mortality and bleeding compared with clopidogrel.
DOI
10.1007/s10557-021-07270-3
PubMed ID
34643836
Recommended Citation
Gupta, R., Malik, A. H., Briasoulis, A., Joshi, A. M., Guthier, D. G., Popli, T., Aronow, W. S., Vyas, A., Patel, N. C., Ahmad, H., & Kluck, B. W. (2021). Comparative Safety and Effectiveness of Loading Doses of P2Y12 Inhibitors in Patients Undergoing Elective PCI: a Network Meta-analysis. LVHN Scholarly Works. Retrieved from https://scholarlyworks.lvhn.org/research-historical-works/26
DOI: 10.1007/s10557-021-07270-3