- Ticagrelor is linked to reduced ischemic events and better survival vs clopidogrel in acute coronary syndrome (ACS), but may entail higher bleeding rates.
- The authors of this network meta-analysis identified ticagrelor as “the most effective strategy” for preventing cardiovascular or all-cause mortality in ACS.
Why this matters
- This analysis incorporates data from the latest randomized controlled trials (RCTs) of oral P2Y12 inhibitors for patients with ACS.
- Median follow-up, 12 months; mean patient age, 63.7 years.
- Included studies generally had low bias risk.
- Risk vs clopidogrel (HRs; 95% CIs) for all-cause mortality (I2, 21.7%):
- Ticagrelor: 0.83 (0.75-0.92).
- Prasugrel: 0.92 (0.84-1.02).
- The 3 did not differ in associations with noncardiovascular mortality risk.
- Risk vs clopidogrel (HRs; 95% CIs) for major bleeding (I2, 35.3%):
- Ticagrelor: 1.27 (1.04-1.55).
- Prasugrel: 1.26 (1.01-1.56).
- Risk vs clopidogrel (HRs; 95% CIs) for cardiovascular mortality (I2, 10.1%):
- Ticagrelor: 0.82 (0.72-0.92).
- Prasugrel: 0.90 (0.80-1.01).
- No differences seen between prasugrel and ticagrelor for any of these outcomes.
- Network meta-analysis of efficacy and safety outcomes in 12 RCTs (6 ticagrelor and 4 prasugrel vs clopidogrel; 2 compared all 3) with 52,816 patients.
- Funding: None.
- No analysis of patient-level data.
- Trial-specific definitions of major bleeding events.