Comparison of new adenosine diphosphate receptor antagonists with clopidogrel in patients with coronary artery disease: a meta-analysis.

Abstract

Recent data suggest the superiority of new adenosine diphosphate (ADP) receptor antagonists compared with clopidogrel in acute coronary syndrome patients. We aimed to assess the risks and benefits of new ADP receptor antagonists in patients with coronary artery disease (CAD). Relevant studies published through February 28, 2014 were searched and identified in the MEDLINE, EMBASE, and Cochrane databases. Summary estimates were obtained using a random-effects model. All nine published randomized controlled studies comparing new ADP receptor antagonists with clopidogrel in CAD were included. The database consisted of 66,900 patients; 33,782 on novel agents, and 33,118 on clopidogrel. New ADP receptor antagonists reduced the composite incidence of all-cause mortality, myocardial infarction or stroke (odds ratio [OR] 0.89, 95 % confidence interval [CI] 0.81-0.97, p = 0.01) but increased the incidence of non-coronary artery bypass grafting-related major bleeding (OR 1.24, 95 % CI 1.08-1.42, p = 0.003). The composite end point of the net rate of adverse clinical events, which was the combination of the primary efficacy end point and the primary safety end point, was significantly lower in the new agent group compared to the clopidogrel group (9.7 versus 10.6 %, OR 0.92, 95 % CI 0.85-1.00). Use of recently introduced new ADP receptor antagonists results in a reduction in adverse clinical outcomes but a substantial increase in bleeding. New agents revealed an improved combined efficacy and safety outcome compared to that of clopidogrel in patients with CAD.