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Efficacy and safety of low dose ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis
  1. Qing Chen1,
  2. Yuanyuan Zhang1,
  3. Zhen Wang1,
  4. Shuai Wang1,
  5. Hao Zhang2,
  6. Yiwen Wang1,
  7. Chi Lu1,
  8. Haochen Xuan3,
  9. Chaofan Wang3,
  10. Dongye Li1,
  11. Tongda Xu1,3
  1. 1Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China
  2. 2Department of Thoracic Cardiovascular Surgery, The Affiliated Hospital of Xuzhou Medical University, XuZhou, JiangSu, China
  3. 3Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
  1. Correspondence to Dr Tongda Xu, Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; xutongda3004{at}163.com; Dr Dongye Li, Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, China; dongyeli{at}xzhmu.edu.cn

Abstract

Our aim was to examine clinical trials, provide guidance to practitioners and estimate the efficacy and safety of two agents by comparing low dose ticagrelor with standard dose clopidogrel in patients with acute coronary syndrome. We systematically looked through Pubmed, Embase, the Cochrane Library, Wanfang data and CNKI for trials comparing low dose ticagrelor with standard dose clopidogrel for the treatment of patients with ACS since the database was created. The primary endpoint for efficacy was the rate of major adverse cardiac events (MACEs). The primary endpoint for safety was the rate of major bleeding events. We also evaluated platelet function between low dose ticagrelor and standard dose clopidogrel in ACS patients. From 6744 articles, 16 studies including 1629 patients met the inclusion criteria. In contrast with standard dose clopidogrel, low dose ticagrelor significantly reduced MACEs (OR 0.39, 95% CI 0.26, 0.58) and the difference was statistically significant (p<0.01). No difference was noted for major bleeding events (OR 1.16, 95% CI 0.43, 3.08) between the two agents (p=0.77). In addition, low dose ticagrelor showed lower platelet aggregation rate than clopidogrel (standardised mean difference (SMD) −0.68, 95% CI −0.83 to 0.53) (p<0.01). Platelet reaction units for low dose ticagrelor were much lower than those for standard dose clopidogrel (SMD −2.46, 95% CI −2.85 to −2.07) (p<0.01). In comparison with standard dose clopidogrel, low dose ticagrelor significantly lowered the incidence of MACEs, improved left ventricular ejection fraction, decreased left ventricular end diastolic dimension and did not expand the risk of major bleeding events or minor or minimal bleeding events in ACS patients with a considerable safety and efficacy profile. In addition, low dose ticagrelor was associated with dramatically lower platelet aggregation compared with standard dose clopidogrel.

  • coronary heart disease
  • cardiology
  • adult cardiology
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Footnotes

  • QC and YZ contributed equally.

  • Contributors TX was responsible for the plan for the current study. TX and QC formulated specific search strategy and looked through Pubmed, Embase, the Cochrane Library and other databases in detail for relevant publications. Three independent researchers (ZW, SW and HZ) reviewed the study titles and abstracts, and potentially relevant articles satisfying the inclusion criteria were reviewed in detail. Trials selected for data extraction and detailed analysis were analysed by two researchers (QC and YW). Disagreements were resolved by a third researcher (CL). QC, YZ and CL performed the meta-analysis for the included studies through Stata (V.11.0). HX and CW assisted in interpreting the results. QC and YZ drafted the manuscript. TX and DL evaluated the data quality and approved the final version of the manuscript for submission. All authors have critically reviewed the manuscript.

  • Funding Key Research Developmental Programme of Jiangsu Province (social development No BE2019639); Jiangsu Province Postgraduate Practice Innovation Program (No SJCX19_0946); and Jiangsu Provincial Administration of Traditional Chinese Medicine (No YB201988).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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