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Article: Systematic review with meta-analysis: the risk of gastrointestinal bleeding in patients taking third-generation P2Y12 inhibitors compared with clopidogrel

TitleSystematic review with meta-analysis: the risk of gastrointestinal bleeding in patients taking third-generation P2Y12 inhibitors compared with clopidogrel
Authors
Issue Date2019
Citation
Alimentary Pharmacology and Therapeutics, 2019, v. 49, n. 1, p. 7-19 How to Cite?
Abstract© 2018 John Wiley & Sons Ltd Background: Ticagrelor and prasugrel are third-generation oral P2Y 12 receptor antagonists with rapid onset and pronounced platelet inhibition. However, higher overall bleeding rates have been reported for these agents when compared with clopidogrel. Aim: To compare the risk of gastrointestinal bleeding (GIB) among users of third-generation P2Y 12 inhibitors with clopidogrel. Methods: We systematically searched for published randomised controlled trials of ticagrelor or prasugrel versus clopidogrel until September 2018. The primary outcome was the risk of GIB among users of third-generation P2Y 12 inhibitors when compared to clopidogrel, expressed as risk ratio (RR) and 95% confidence interval (CI). The rates of non-coronary artery bypass graft (CABG) major bleeding, life-threatening bleeding, fatal bleeding, and intracranial bleeding were analysed as secondary outcomes. Results: Forty-one studies were included in the analysis of non-CABG major bleeding, of which 12 were included in the analysis of GIB including 58 678 patients. Third-generation P2Y 12 inhibitors were associated with higher risk of GIB as compared with clopidogrel (RR 1.28, 95% CI 1.13-1.46). The findings were consistent for upper (RR 1.32, 95% CI 1.05-1.67) and unspecified GIB (RR 1.25, 95% CI 1.01-1.53), but not lower GIB (RR 1.25, 95% CI 0.95-1.65). Subgroup analysis showed higher GIB risk in prasugrel studies (RR 1.40, 95% CI 1.10-1.77) than in ticagrelor studies (RR 1.15, 95% CI 0.94-1.39). Third-generation P2Y 12 inhibitors also increased the risk of non-CABG major bleeding (RR 1.18, 95% CI 1.08-1.28). Conclusion: Third-generation P2Y 12 inhibitors were associated with increased risk of GIB and non-CABG major bleeding when compared with clopidogrel.
Persistent Identifierhttp://hdl.handle.net/10722/268937
ISSN
2017 Impact Factor: 7.357
2015 SCImago Journal Rankings: 2.833
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorGuo, CG-
dc.contributor.authorChen, L-
dc.contributor.authorChan, EW-
dc.contributor.authorCheung, KSM-
dc.contributor.authorIsshiki, T-
dc.contributor.authorWong, ICK-
dc.contributor.authorLeung, WK-
dc.date.accessioned2019-04-07T15:08:57Z-
dc.date.available2019-04-07T15:08:57Z-
dc.date.issued2019-
dc.identifier.citationAlimentary Pharmacology and Therapeutics, 2019, v. 49, n. 1, p. 7-19-
dc.identifier.issn0269-2813-
dc.identifier.urihttp://hdl.handle.net/10722/268937-
dc.description.abstract© 2018 John Wiley & Sons Ltd Background: Ticagrelor and prasugrel are third-generation oral P2Y 12 receptor antagonists with rapid onset and pronounced platelet inhibition. However, higher overall bleeding rates have been reported for these agents when compared with clopidogrel. Aim: To compare the risk of gastrointestinal bleeding (GIB) among users of third-generation P2Y 12 inhibitors with clopidogrel. Methods: We systematically searched for published randomised controlled trials of ticagrelor or prasugrel versus clopidogrel until September 2018. The primary outcome was the risk of GIB among users of third-generation P2Y 12 inhibitors when compared to clopidogrel, expressed as risk ratio (RR) and 95% confidence interval (CI). The rates of non-coronary artery bypass graft (CABG) major bleeding, life-threatening bleeding, fatal bleeding, and intracranial bleeding were analysed as secondary outcomes. Results: Forty-one studies were included in the analysis of non-CABG major bleeding, of which 12 were included in the analysis of GIB including 58 678 patients. Third-generation P2Y 12 inhibitors were associated with higher risk of GIB as compared with clopidogrel (RR 1.28, 95% CI 1.13-1.46). The findings were consistent for upper (RR 1.32, 95% CI 1.05-1.67) and unspecified GIB (RR 1.25, 95% CI 1.01-1.53), but not lower GIB (RR 1.25, 95% CI 0.95-1.65). Subgroup analysis showed higher GIB risk in prasugrel studies (RR 1.40, 95% CI 1.10-1.77) than in ticagrelor studies (RR 1.15, 95% CI 0.94-1.39). Third-generation P2Y 12 inhibitors also increased the risk of non-CABG major bleeding (RR 1.18, 95% CI 1.08-1.28). Conclusion: Third-generation P2Y 12 inhibitors were associated with increased risk of GIB and non-CABG major bleeding when compared with clopidogrel.-
dc.languageeng-
dc.relation.ispartofAlimentary Pharmacology and Therapeutics-
dc.titleSystematic review with meta-analysis: the risk of gastrointestinal bleeding in patients taking third-generation P2Y12 inhibitors compared with clopidogrel-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1111/apt.15059-
dc.identifier.pmid30506985-
dc.identifier.scopuseid_2-s2.0-85058016030-
dc.identifier.volume49-
dc.identifier.issue1-
dc.identifier.spage7-
dc.identifier.epage19-
dc.identifier.eissn1365-2036-
dc.identifier.isiWOS:000452872100003-

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