Ticagrelor versus Clopidogrel, Drug of Choice for the Prevention of Stent Thrombosis after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Abstract

Objectives: The objective of this meta-analysis of randomized controlled trials was to compare the efficacy of ticagrelor versus Clopidogrel for preventing stent thrombosis (ST) following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methodology: A comprehensive literature search was conducted using MEDLINE/PubMed, EMBASE, Web of Science, and the Cochrane Library. The inclusion criteria involved selecting randomized controlled trials that included patients with ACS undergoing PCI, comparing the use of ticagrelor and Clopidogrel, having a follow-up period of at least 30 days, and reporting data on ST. The meta-analysis was performed using the R statistical software version 4.1.1, and the "meta" package was utilized. The Mantel-Haenszel method was employed to calculate the relative risk (RR) and corresponding 95% confidence interval (CI) for comparing the risk of ST between the two treatment groups. Results: A total of seven randomized controlled trials were included in the analysis, comprising a population of 28,609 patients with ACS who were randomized to receive either ticagrelor or Clopidogrel in a ratio of 12,116:16,493. The cumulative rate of ST was found to be 2.2% (185/8,423) in the ticagrelor group and 2.7% (347/12,851) in the clopidogrel group. The meta-analysis revealed a significant decrease in the rate of ST with ticagrelor compared to Clopidogrel, demonstrating a relative risk of 0.71 (95% CI: 0.59 to 0.85). No heterogeneity was detected among the included studies, as indicated by an I2 value of 0% and a p-value of 0.463. Conclusion: In conclusion, the findings of this meta-analysis suggest that ticagrelor is a significantly more effective P2Y12 inhibitor than Clopidogrel for preventing ST following PCI in patients with ACS. These results support using ticagrelor as the preferred antiplatelet therapy in this patient population.