P2Y12 Receptor Antagonists: Which One to Choose? A Systematic Review and Meta-Analysis.
Pharmacological properties of the currently available P2Y12 receptor antagonists differ significantly and lead to different degrees of platelets inhibition and cardiovascular outcomes.



We performed a systematic review and meta-analysis of the comparative effects of newer antiplatelet agents versus clopidogrel on major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), stroke, major bleeding and stent thrombosis, in patients with acute coronary syndromes (ACS) and/or undergoing percutaneous coronary intervention (PCI).



We identified 11 prospective randomized studies comparing newer antiplatelets to clopidogrel. The total number of participants included in meta-analysis was 70239. The total number of participants treated with clopidogrel was 34792 while 35447 patients were assigned to newer P2Y12 inhibitors, of which 29.4% received ticagrelor, 35.2% prasugrel and 35.4% were loaded with intravenous cangrelor. Ticagrelor use was associated with significantly reduced MACE, all-cause mortality, myocardial infarction and stent thrombosis and similar rates of stroke and major bleeding compared to clopidogrel in patients with ACS and/or PCI. Prasugrel use was associated with significantly lower rates of MACE, MI and stent thrombosis but significantly high rates of major bleeding and thus no all-cause mortality benefit compared to clopidogrel.



Newer P2Y12 receptor antagonists are associated with better cardiovascular outcomes in patients with ACS and/or undergoing PCI. Prasugrel use resulted in higher major bleeding rates and no overall mortality benefit compared with clopidogrel.
Wayne State University/Detroit Medical Center, Department of Cardiology, Detroit, IL 48226, USA.
Alexandros
A
Briasoulis
Tesfaye
T
Telila
Mohan
M
Palla
Gerasimos
G
Siasos
Dimitris
D
Tousoulis
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists