title: Cancer Event Rate and Mortality with Thienopyridines: A Systematic Review and Meta-Analysis.
abstract: Thienopyridines are a class of antiplatelet drugs widely used in cardiovascular disease prevention and treatment. A recent concern has come to light regarding the safety of thienopyridines because of the possible risk of malignancy. We therefore performed a systematic review and meta-analysis to evaluate the association between thienopyridine exposure and malignancy.
  
  
  
  We searched the MEDLINE and EMBASE databases in March 2016 for studies that evaluated incident cancer and cancer mortality with and without exposure to thienopyridines. Relevant studies were identified, and data were extracted and analysed using random-effects meta-analysis.
  
  
  
  A total of nine studies (six randomised controlled trials and three cohort studies) that included 282,084 participants were included. The cancer event rate with clopidogrel and prasugrel was 3.25% and 1.58% respectively. When compared with standard aspirin or placebo, thienopyridines are not significantly associated with cancer mortality and event rate (odds ratio [OR] 1.12, 95% confidence interval [CI] 0.80-1.56, n = 3; and OR 0.92, 95% CI 0.52-1.64, n = 2, respectively. Further analyses examining clopidogrel showed no significant association with cancer event rate or malignancy-related death. When comparing prasugrel with clopidogrel, no significant association was noted for cancer event rate (OR 1.10, 95% CI 0.89-1.37, n = 2]. Subanalyses according to cancer location showed that thienopyridines are not significantly associated with malignancy mortality and/or incidence.
  
  
  
  Our results suggest that there is currently insufficient evidence to suggest that thienopyridine exposure is associated with an increased risk of cancer event rate or mortality.
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK. rafailkotronias@gmail.com.|Oxford University Clinical Academic Graduate School, Oxford University, Oxford, UK. rafailkotronias@gmail.com.
authors.forename: Rafail Angelos
authors.initials: RA
authors.lastname: Kotronias
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
authors.forename: Chun Wai
authors.initials: CW
authors.lastname: Wong
authors.affiliation: University Hospital of Wales, Cardiff, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Kinnaird
authors.affiliation: Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK.
authors.forename: Azfar
authors.initials: A
authors.lastname: Zaman
authors.affiliation: Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.|Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D000077144:Clopidogrel; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; 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; D012306:Risk; D058924:Thienopyridines / Q000008:administration & dosage / Q000009:adverse effects*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D058924:Thienopyridines; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin