Efficacy and safety of ticagrelor versus clopidogrel in patients with stable coronary artery diseases: a systematic review and meta-analysis

Abstract

Objective: Ticagrelor has been recommended for acute coronary syndrome with percutaneous coronary intervention, but its efficacy and safety comparative to clopidogrel in patients with stable coronary artery disease remains inconsistent. Methods: This was a systematic review and meta-analysis. Embase and Medline was searched through November 2019. Studies were eligible when they compared ticagrelor and clopidogrel in patients with stable coronary artery disease regarding the outcomes of interest. Patient characteristics, treatment regimens, and outcome data were extracted. The primary outcome was major adverse cardiac events (MACE), and the secondary outcomes included major bleeding, cardiovascular death, and non-fatal myocardial infarction (MI). Random-effects model was used to combine the results across studies. Sensitivity analysis by including only randomised trials was conducted. Results: Out of 231 citations, three studies (2 randomised trials and 1 cohort study) with 8827 patients (4353 on ticagrelor and 4474 on clopidogrel) were eligible. The median follow-up time ranged from 17 months to 24 months. Overall, compared with clopidogrel, ticagrelor did not show significant difference in reducing the risks of MACE (relative risk [RR]=0.87, 95% confidence interval [CI]=0.72-1.07), non-fatal MI (RR=0.67, 95% CI=0.24-1.88), cardiovascular death (RR=1.51, 95% CI=0.35-6.51), and major bleeding (RR=1.32, 95% CI=0.97-1.79). Similar results were also observed in sensitivity analysis. Conclusion: This study did not provide evidence that ticagrelor was more effective or safer than clopidogrel in patients with stable coronary artery disease. However, the small number of included studies should be borne in mind when interpreting the results.