Table 21Detailed strength of evidence for UA/NSTEMI patients treated with clopidogrel versus ticagrelor or prasugrel

Number of Studies (Patients)DomainsStrength of Evidence
Magnitude of Effect
Effect Estimate (95% CI)
Risk of Bias: Study Design/QualityConsistencyDirectnessPrecision
Composite ischemic Endpoints up to 30 Months
Ticagrelor vs. clopidogrel
1 (5216)
RCT/Good qualityNADirectPreciseModerate SOE
HR 0.85 (0.73 to 1.00)
Favors ticagrelor
Prasugrel vs. clopidogrel
1 (7243)
RCT/Good qualityNADirectPreciseModerate SOE
HR 0.91 (0.79 to 1.05)
No difference
Mortality up to 30 Months
Ticagrelor vs. clopidogrel
1 (5216)
RCT/Good qualityNADirectPreciseModerate SOE
HR 0.75 (0.61 to 0.93)
Favors ticagrelor
Prasugrel vs. clopidogrel
1 (7243)
RCT/Good qualityNADirectPreciseModerate SOE
HR 0.96 (0.79 to 1.16)
No difference
Nonfatal MI up to 30 Months
Ticagrelor vs. clopidogrel
1 (5216)
RCT/Good qualityNADirectPreciseModerate SOE
HR 0.94 (0.77 to 1.15)
No difference
Prasugrel vs. clopidogrel
1 (7243)
RCT/Good qualityNADirectPreciseModerate SOE
HR 0.89 (0.74 to 1.07)
No difference
Stroke up to 30 Months
Ticagrelor vs. clopidogrel
1 (5216)
RCT/Good qualityNADirectImpreciseInsufficient SOE
HR 1.35 (0.89 to 2.07)
Insufficient evidence due to imprecision
Prasugrel vs. clopidogrel
1 (7243)
RCT/Good qualityNADirectImpreciseInsufficient SOE
HR 0.67 (0.42 to 1.06)
Insufficient evidence due to imprecision
Revascularization up to 12 Months
Ticagrelor vs. clopidogrel
1 (5216)
RCT/Good qualityNADirectUnknownModerate SOE
No difference
Major Bleeding up to 30 Months
Ticagrelor vs. clopidogrel
1 (5216)
RCT/Good qualityNADirectPreciseModerate SOE
HR 1.17 (0.98 to 1.39)
Favors clopidogrel
Prasugrel vs. clopidogrel
1 (7243)
RCT/Good qualityNADirectImpreciseInsufficient SOE
HR 1.31 (0.81 to 2.11)
Insufficient evidence due to imprecision
Major or Minor Bleeding up to 30 Months
Ticagrelor vs. clopidogrel
1 (5216)
RCT/Good qualityNADirectPreciseModerate SOE
HR 1.17 (1.01 to 1.36)
Favors clopidogrel
Prasugrel vs. clopidogrel
1 (7243)
RCT/Good qualityNADirectImpreciseLow SOE
HR 1.54 (1.06 to 2.23)
Favors clopidogrel

CI = confidence interval; GPI = glycoprotein inhibitor; HR = hazard ratio; MI = myocardial infarction; RCT = randomized controlled trial; SOE = strength of evidence; UA/NSTEMI = unstable angina/non-ST elevation myocardial infarction; UFH = unfractionated heparin

From: Results

Cover of Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non–ST Elevation Myocardial Infarction
Antiplatelet and Anticoagulant Treatments for Unstable Angina/Non–ST Elevation Myocardial Infarction [Internet].
Comparative Effectiveness Reviews, No. 129.
Melloni C, Jones WS, Washam JB, et al.

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