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Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting.

Abstract：

OBJECTIVES:We sought to determine whether clopidogrel is at least as efficacious as ticlopidine. BACKGROUND:Several trials have supported the enhanced safety and tolerability of clopidogrel compared with ticlopidine after coronary stent deployment. However, none of these individual trials were powered to detect possible differences in the efficacy for reducing ischemic end points. METHODS:Published data from trials and registries that compared clopidogrel with ticlopidine in patients receiving coronary stents were pooled, and a formal meta-analysis was performed. The rate of 30-day major adverse cardiac events (MACE), as defined in each trial, was used as the primary end point. RESULTS:There were a total of 13,955 patients. The pooled rate of major adverse cardiac events was 2.10% in the clopidogrel group and 4.04% in the ticlopidine group. After adjustment for heterogeneity in the trials, the odds ratio (OR) of having an ischemic event with clopidogrel, as compared with ticlopidine, was 0.72 (95% confidence interval [CI] 0.59 to 0.89, p = 0.002). Mortality was also lower in the clopidogrel group compared with the ticlopidine group-0.48% versus 1.09% (OR 0.55, 95% CI 0.37 to 0.82; p = 0.003). CONCLUSIONS:Based on all available evidence from randomized clinical trials or registries, clopidogrel, in addition to better tolerability and fewer side effects, is at least as efficacious as ticlopidine in reducing MACE. This finding may be due to the more rapid onset of an antiplatelet effect seen with the loading dose of clopidogrel, which was used in most of these studies, or to better patient compliance with clopidogrel therapy. Therefore, clopidogrel plus aspirin should replace ticlopidine plus aspirin as the standard antiplatelet regimen after stent deployment.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Bhatt DL,Bertrand ME,Berger PB,L'Allier PL,Moussa I,Moses JW,Dangas G,Taniuchi M,Lasala JM,Holmes DR,Ellis SG,Topol EJ

doi

10.1016/s0735-1097(01)01713-2

subject

Has Abstract

pub_date

2002-01-02 00:00:00

pages

9-14

issue

eissn

0735-1097

issn

1558-3597

pii

S0735109701017132

journal_volume

pub_type

杂志文章,meta分析

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Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting.