Novel Oral P2Y12 Inhibitor Prasugrel vs. Clopidogrel in Patients with Acute Coronary Syndrome: Evidence Based on 6 Studies

Source of support: Departmental sources Background: Whether prasugrel can take the place of clopidogrel for patients with acute coronary syndrome (ACS) is not clear. The aim of this study was to perform a meta-analysis for systematically reviewing the evidence on pra-sugrel in comparison to clopidogrel in patients with ACS. Material/Methods: Relevant prospective and retrospective studies were searched in databases. Six studies were finally included. Pooled risk ratios (RRs) and 95 % confidence intervals (CIs) were calculated to assess all causes of death, myo-cardial infarction (MI), stroke, major bleeding, major/minor bleeding, and stent thrombosis (for PCI performed). Results: Compared with clopidogrel, prasugrel had similar risks of all cause of death (Pooled RR: 0.83; 95 % CI: 0.64–1.06, p=0.14, I2=55%), MI (Pooled RR: 0.86; 95 % CI: 0.71–1.04, p=0.12) and stroke (pooled RR: 0.88; 95 % CI: 0.70–1.10, p=0.25). However, prasugrel was associated with significantly higher risk of both major bleeding (Pooled RR: 1.19; 95 % CI: 0.99–1.44, p=0.06, I2=0%) and the risk of total major and minor bleeding (Pooled RR: 1.30; 95% CI: 1.15–1.48, p<0.0001, I2=0%). For the patients who underwent percutaneous coronary intervention (PCI), prasugrel was associated with significantly lower risk of stent thrombosis (Pooled RR: 0.47; 95 % CI: 0.34–0.61, p<0.00001, I2=0%). Conclusions: Prasugrel has similar effects as clopidogrel in terms of all causes of death, MI, and stroke in ACS patients. Fo