title: Meta-analysis of Comparison of the Newer P2Y12 Inhibitors (Oral Preparation or Intravenous) to Clopidogrel in Patients With Acute Coronary Syndrome.
abstract: OBJECTIVE
  New P2Y12 adenosine diphosphate receptor antagonists have been used in the treatment of acute coronary syndrome (ACS) with different results. This systematic review analyzed and compared the evidence from large, clinical trials regarding the efficacy of clopidogrel relative to that of cangrelor, prasugrel, and ticagrelor in reducing the incidence of cardiovascular events in patients with ACS.
  
  
  RESULTS
  This analysis compared newer P2Y12 inhibitors with clopidogrel of 13 clinical trials involved a total of 87,985 patients with ACS. The newer P2Y12 inhibitors include cangrelor, prasugrel, and ticagrelor. Newer P2Y12 inhibitors significantly decreased the risk of myocardial infarction and showed a trend toward reduction of cardiovascular death (odds ratio [OR] = 0.86, 95% confidence interval [CI], 0.77-0.96, and I = 54%, P < 0.05); (OR = 0.85, 95% CI, 0.77-0.93, and I = 42%, P < 0.001). The rates of stroke events and the incidence in patients with ACS did not differ statistically between the clopidogrel group and the group with newer P2Y12 inhibitors (OR = 0.95, 95% CI, 0.79-1.14, and I = 0%, P = 0.57). However, newer P2Y12 inhibitors showed a significant increase in thrombosis in MI major or minor bleeding (OR = 1.21, 95% CI, 1.03-1.42, and I = 56%, P = 0.02) compared with clopidogrel.
  
  
  CONCLUSIONS
  Based on this meta-analysis, newer P2Y12 inhibitors were significantly more effective than clopidogrel in the events of myocardial infarction and cardiovascular death in patients with ACS, although the incidence of thrombosis in MI-defined bleeding was higher compared with clopidogrel.
authors.affiliation: *Department of Pharmacy, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China; and †Clinical Research Center, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhang
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.forename: Weihua
authors.initials: W
authors.lastname: Dong
authors.forename: Huiping
authors.initials: H
authors.lastname: Tian
authors.forename: Weiyi
authors.initials: W
authors.lastname: Feng
authors.forename: Haisheng
authors.initials: H
authors.lastname: You
authors.forename: Hairong
authors.initials: H
authors.lastname: He
authors.forename: Jing
authors.initials: J
authors.lastname: Ma
authors.forename: Yalin
authors.initials: Y
authors.lastname: Dong
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D061605:Administration, Intravenous; D000284:Administration, Oral; D000077144:Clopidogrel; D006801:Humans; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D013988:Ticlopidine