Abstract 14255: Effectiveness and Safety of Ticagrelor versus Clopidogrel in Acute Coronary Syndrome: A Meta-Analysis of Real - World Data

Abstract

Background: Ticagrelor, a potent P2Y12 inhibitor, was superior to clopidogrel in preventing mortality post acute coronary syndrome (ACS) without a major safety concern in the PLATO trial. Nevertheless, the real-world evidence of ticagrelor post ACS is conflicting and inconclusive. Therefore, we conducted a meta-analysis to assess the effectiveness and safety of ticagrelor versus clopidogrel post ACS using real-world data. Methods: We performed a meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed to identify observational studies exploring the effectiveness and safety of ticagrelor and versus clopidogrel in ACS until 12/01/2022. Two independent reviewers assessed the quality and risk of bias of the included studies. A random-effect model was used to combine data. Effectiveness outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stent thrombosis. Safety outcomes included major bleeding, gastrointestinal (GI) bleeding, and dyspnea. Results: A total of 26 observational studies comparing ticagrelor to clopidogrel post ACS were included. Compared to clopidogrel, ticagrelor significantly reduced all-cause mortality (odds ratio [OR], 0.68 [95% CI, 0.58-0.81], I 2 = 78%)) and cardiovascular mortality (OR, 0.64 [95% CI, 0.48-0.85], I 2 = 78%). Whereas there was no statically significant difference between ticagrelor and clopidogrel in MI and stent thrombosis (OR, 0.92 [95% CI, 0.81-1.05] I 2 =56%) and (OR, 0.61 [95% CI, 0.23-1.66], I 2 = 89%), respectively. Ticagrelor was associated with significantly higher major bleeding incidence (OR, 1.21 [95% CI, 1.06-1.39], I 2 =52%). However, GI bleeding and dyspnea were not significantly increased with ticagrelor use. Conclusions: Real-world data of ticagrelor use post ACS demonstrated that ticagrelor reduced all-cause mortality and cardiovascular mortality in comparison to clopidogrel. However, it was associated with increased major bleeding. Real-world evidence with long follow-up confirming the safety of ticagrelor in comparison to clopidogrel post ACS demonstrated in controlled trials is warranted.