Abstract
Background: There is controversy among physicians regarding the use of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients treated with coronary artery bypass grafting (CABG). Moreover, the evidence of previous studies about this topic remained inconclusive. This study aimed to perform a meta-analysis concerning the relation between the risk of major bleeding and the use of different DAPT (clopidogrel or ticagrelor) in ACS patients treated with CABG. Methods: A meta-analysis was conducted during March to October 2019. Searches were carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor covariate in our present study was DAPT (clopidogrel or ticagrelor), and the outcome measure was the risk of major bleeding. Sub-group analysis was also performed, where data were classified into pre- and post-CABG. Furthermore, to determine the correlation and effect estimation, data were analyzed using fixed or random effect model. Results: A total of 13 studies consisting 34,015 patients treated with clopidogrel and 32,661 patients treated with ticagrelor was included in our study. Our pooled calculation revealed that the incidence of major bleeding was not different significantly between clopidogrel and ticagrelor. In pre- and post-CABG sub-groups, our results also found no significant difference in major bleeding incidence between clopidogrel and ticagrelor groups. Conclusions: Our meta-analysis clarifies that clopidogrel, compared to ticagrelor, or vice versa, is not associated with the risk of major bleeding in ACS patients treated with CABG.
Highlights
In the last two decades, the management of acute coronary syndrome (ACS) has been well defined and periodically updated
2016 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines recommended ticagrelor over clopidogrel because ticagrelor is considered to have a more potent anti-platelet effect than clopidogrel[14], the evidence from previous studies regarding the association between the risk of major bleeding and the use of different dual antiplatelet therapy (DAPT) using either clopidogrel or ticagrelor in ACS patients treated with coronary artery bypass grafting (CABG) were inconclusive
Eligibility criteria and data extraction The inclusion criteria for this study were (1) retrospective studies, (2) prospective studies, (3) randomized controlled trials (RCTs), (4) evaluating the association between the incidence of major bleeding and DAPT either using clopidogrel or ticagrelor in ACS patients treated with CABG, (5) providing sufficient data for calculation of odd ratio (OR) with 95% CI
Summary
In the last two decades, the management of acute coronary syndrome (ACS) has been well defined and periodically updated. Management options are numerous, and they depend on the facilities of the hospital Of these treatment options, coronary artery bypass grafting (CABG) is considered the most challenging and the final option when other treatment options, including percutaneous coronary intervention (PCI) and thrombolytic therapy, fail to restore blood flow in the infarct-related artery[2]. The drugs used in ACS patients in all management options are complex, and dual antiplatelet therapy (DAPT) is commonly used. There is controversy among physicians regarding the use of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients treated with coronary artery bypass grafting (CABG). This study aimed to perform a meta-analysis concerning the relation between the risk of major bleeding and the use of different DAPT (clopidogrel or ticagrelor) in ACS patients treated with CABG.
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