title: Novel oral P2Y12 inhibitor prasugrel vs. clopidogrel in patients with acute coronary syndrome: evidence based on 6 studies.
abstract: BACKGROUND
  Whether prasugrel can take the place of clopidogrel for patients with acute coronary syndrome (ACS) is not clear. The aim of this study was to perform a meta-analysis for systematically reviewing the evidence on prasugrel in comparison to clopidogrel in patients with ACS.
  
  
  METHODS
  Relevant prospective and retrospective studies were searched in databases. Six studies were finally included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to assess all causes of death, myocardial infarction (MI), stroke, major bleeding, major/minor bleeding, and stent thrombosis (for PCI performed).
  
  
  RESULTS
  Compared with clopidogrel, prasugrel had similar risks of all cause of death (Pooled RR: 0.83; 95% CI: 0.64-1.06, p=0.14, I2=55%), MI (Pooled RR: 0.86; 95% CI: 0.71-1.04, p=0.12) and stroke (pooled RR: 0.88; 95% CI: 0.70-1.10, p=0.25). However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95% CI: 0.99-1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15-1.48, p<0.0001, I2=0%). For the patients who underwent percutaneous coronary intervention (PCI), prasugrel was associated with significantly lower risk of stent thrombosis (Pooled RR: 0.47; 95% CI: 0.34-0.61, p<0.00001, I2=0%).
  
  
  CONCLUSIONS
  Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients. For the patients who underwent PCI, prasugrel contributes to lower risk of stent thrombosis. However, prasugrel is associated with significantly higher risk of bleeding. For the patients with active pathological bleeding or a history of stroke and/or TIA, prasugrel should not be recommended.
authors.affiliation: Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).
authors.forename: Min
authors.initials: M
authors.lastname: Jia
authors.affiliation: Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).
authors.forename: Zaibo
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).
authors.forename: Hongtao
authors.initials: H
authors.lastname: Chu
authors.affiliation: Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Medicine, Zaozhuang Municipal Hospital, Zaozhuang, Shandong, China (mainland).
authors.forename: Keyong
authors.initials: K
authors.lastname: Chen
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D000284:Administration, Oral; D000077144:Clopidogrel; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine