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Cardiovasc Revasc Med. 2018 Sep;19(6):689-694. doi: 10.1016/j.carrev.2018.01.009. Epub 2018 Jan 31.

Ticagrelor versus clopidogrel in East Asian patients with acute coronary syndrome: Systematic review and meta-analysis.

Author information

1
Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, 900S. Limestone Street, 326 Wethington Building, Lexington, KY 40536, USA. Electronic address: nmisumida@uky.edu.
2
Mount Sinai Beth Israel, Department of Cardiology, 1st Avenue at 16th Street, New York, NY 10003, USA.. Electronic address: saoi@chpnet.org.
3
Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, 900S. Limestone Street, 326 Wethington Building, Lexington, KY 40536, USA. Electronic address: sunmoon.kim@uky.edu.
4
Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, 900S. Limestone Street, 326 Wethington Building, Lexington, KY 40536, USA. Electronic address: kziad2@uky.edu.
5
Gill Heart and Vascular Institute and Division of Cardiovascular Medicine, University of Kentucky, 900S. Limestone Street, 326 Wethington Building, Lexington, KY 40536, USA. Electronic address: abdel-latif@uky.edu.

Abstract

BACKGROUND:

Bleeding complications are associated with unfavorable outcomes in patients with acute coronary syndrome (ACS). Compared to Whites, several studies demonstrated a higher risk of bleeding in Asians who present with acute myocardial infarction. To date, the efficacy and safety of ticagrelor in East Asian population have not been well established.

METHODS:

We conducted a systematic review and meta-analysis of randomized controlled trials that compared ticagrelor and clopidogrel in East Asian patients with acute coronary syndrome (ACS). We systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov database.

RESULTS:

Three randomized controlled trials, including a total of 1552 patients, met our inclusion criteria. Study countries included Japan, South Korea, and China. All studies defined primary efficacy endpoint and major bleeding events in accordance with the PLATO definition. Ticagrelor was associated with a numerically lower, albeit statistically nonsignificant, risk of primary efficacy endpoint defined as a composite of death from vascular causes, myocardial infarction, or stroke (odds ratio 0.84; 95% confidence interval 0.43-1.63; p = 0.60). Ticagrelor was associated with a significantly higher risk of PLATO-defined major bleeding compared to clopidogrel (odds ratio 1.52; 95% confidence interval 1.04-2.23; p = 0.03).

CONCLUSIONS:

Our meta-analysis demonstrated that ticagrelor was associated with a higher risk of major bleeding compared to clopidogrel in East Asian patients with ACS. Further studies evaluating the role of ticagrelor in management of ACS in East Asian patients are warranted.

KEYWORDS:

Acute coronary syndrome; Clopidogrel; East Asian; Ticagrelor

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