title: Safety and Efficacy of Switching From Clopidogrel to Prasugrel in Patients Undergoing Percutaneous Coronary Intervention: A Study-level Meta-analysis From 15 Studies.
abstract: BACKGROUND
  There is poor evidence on clinical outcome of switching from clopidogrel to prasugrel in patients undergoing percutaneous coronary intervention.
  
  
  OBJECTIVE
  Data on the topic are limited and we performed a study-level meta-analysis to assess safety and efficacy of such strategy.
  
  
  METHODS
  A total of 15 studies and 3974 patients were included. The following comparisons were performed: prasugrel switching versus prasugrel only therapy; and prasugrel switching versus clopidogrel only therapy. Outcome measures were overall bleeding, major bleeding, and major adverse cardiac events (MACE).
  
  
  RESULTS
  There was no statistically significant increased bleeding risk in the prasugrel switching versus prasugrel only group [overall bleeding: OR 1.07, 95% confidence interval (CI), 0.69-1.66; P = 0.77; major bleeding: OR 0.69, 95% CI, 0.32-1.49; P = 0.34]; MACE rates were also comparable. Incidence of safety end points was similar in the prasugrel switching and clopidogrel only groups (overall bleeding: OR 1.27, 95% CI, 0.75-2.15; P = 0.37; major bleeding: OR 0.70, 95% CI, 0.29-1.68; P = 0.42); occurrence of MACE was 3.8% in the prasugrel switching versus 8.3% in the clopidogrel only group (P = 0.23). No statistically significant difference in the safety outcomes was present stratifying by clinical presentation.
  
  
  CONCLUSIONS
  Switching from clopidogrel to prasugrel does not increase bleeding complications during follow-up of patients undergoing percutaneous coronary intervention; however, the strength of the data is not sufficient to make definitive clinical recommendations.
authors.affiliation: *Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy; and †Department of Cardiovascular Sciences, European Hospital of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Patti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ricottini
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.forename: Ilaria
authors.initials: I
authors.lastname: Cavallari
mesh_terms: D000077144:Clopidogrel; D057915:Drug Substitution; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine