Ticagrelor versus clopidogrel in East-Asian patients with acute coronary syndromes: a meta-analysis of randomized trials

Abstract

Aim: To determine whether ticagrelor or clopidogrel provides the best outcomes for East-Asian patients with acute coronary syndrome (ACS).

Materials & methods: Identification and interrogation of electronic databases through 26 July 2016 revealed fully randomized and controlled trials wherein primary efficacy end points were major adverse cardiovascular events and all-cause death among East-Asian patients with ACS. Major bleeding and noncoronary artery bypass grafts major bleeding were primary safety end points.

Results: Two studies met the inclusion criteria. Compared with clopidogrel, ticagrelor has no statistical difference in the end points of major adverse cardiovascular events (risk ratio [RR]: 1.08; 95% CI: 0.62-1.91; p = 0.7260), myocardial infarction (RR: 1.200; 95% CI: 0.64-2.24; p = 0.5669), stroke (RR: 1.11; 95% CI: 0.46-2.66; p = 0.8165), cardiovascular death (RR: 0.89; 95% CI: 0.48-1.65; p = 0.7150), or all-cause mortality (RR: 0.92; 95% CI: 0.43-1.96; p = 0.8252). When compared with clopidogrel, it was found that ticagrelor provoked marked increases in major bleeding (RR: 1.48; p = 0.0430) and noncoronary artery bypass grafts-associated major bleeding (RR: 1.62; p = 0.0454).

Conclusion: Ticagrelor and clopidogrel displayed similar efficacies in ACS presenting patients from East Asia. Administration of ticagrelor also displays some side effects including an increased risk of major bleeding.

Keywords: acute coronary syndrome; clopidogrel; major adverse cardiovascular events; meta-analysis; ticagrelor.