Clinical Efficacy and Safety of Reduced-Dose Prasugrel versus Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Publisher: Taiwan Society of Cardiology Country of Publication: China (Republic : 1949- ) NLM ID: 101687085 Publication Model: Print Cited Medium: Print ISSN: 1011-6842 (Print) Linking ISSN: 10116842 NLM ISO Abbreviation: Acta Cardiol Sin Subsets: PubMed not MEDLINE

Original Publication: Taipei : Taiwan Society of Cardiology

Objectives: This systematic review and meta-analysis of randomized controlled trials (RCTs) compared the clinical efficacy and safety of reduced-dose prasugrel (loading dose: 20 mg; daily maintenance dose: 3.75 mg) and clopidogrel in patients undergoing percutaneous coronary intervention (PCI).
Methods: PubMed, Embase, and the Cochrane Library database were searched for relevant articles from inception to March 8, 2021. Only RCTs that compared the clinical efficacy and safety of reduced-dose prasugrel and clopidogrel treatment in adult patients undergoing PCI were included. The primary outcome was the risk of major cardiovascular events (MACEs).
Results: Four RCTs involving 2464 patients were included. The overall risk of MACEs was 8.3% (102/1235) in the study group (reduced-dose prasugrel) and 9.8% (121/1229) in the control group (clopidogrel). No significant difference was observed in the risk of MACEs between the study and control groups (risk ratio: 0.84, 95% confidence interval: 0.65-1.08, I ² = 0%). In addition, cardiovascular-related death, all-cause death, nonfatal myocardial infarction, nonfatal stroke, revascularization, and stent thrombosis did not differ significantly between the two groups. Apart from a higher risk of minor bleeding in the study group, reduced-dose prasugrel had a similar bleeding risk to clopidogrel.
Conclusions: The clinical efficacy of reduced-dose prasugrel is comparable to that of clopidogrel; however, the risk of minor bleeding should be considered when prescribing this regimen for patients undergoing PCI.

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Keywords: Bleeding; Clopidogrel; Coronary artery disease; Major cardiovascular event; Prasugrel

Date Created: 20220725 Latest Revision: 20220726

20240105

PMC9295039

10.6515/ACS.202207_38(4).20220319A

35873133