Is there Sex-related Outcome Difference According to oral P2Y12 Inhibitors in Patients with Acute Coronary Syndromes? A Systematic Review and Meta-Analysis of 107,126 Patients.

Abstract

BACKGROUND AND OBJECTIVES:

The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes.

METHODS:

Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel.

RESULTS:

Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men.

CONCLUSION:

In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.

• Authors: Oliver Brown, Jennifer Rossington, Gill Louise Buchanan, Giuseppe Patti, Angela Hoye
• Journal: Current vascular pharmacology (Curr Vasc Pharmacol) Vol. 17 Issue 2 Pg. 191-203 ( 2019) ISSN: 1875-6212 [Electronic] United Arab Emirates
• PMID: 29359672 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright© Bentham Science Publishers; For any queries, please email at [email protected].

Chemical References

• Platelet Aggregation Inhibitors
• Purinergic P2Y Receptor Antagonists

Topics

• Acute Coronary Syndrome (blood, diagnosis, drug therapy, epidemiology)
• Administration, Oral
• Female
• Hemorrhage (chemically induced, epidemiology)
• Humans
• Male
• Platelet Aggregation (drug effects)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Purinergic P2Y Receptor Antagonists (administration & dosage, adverse effects)
• Risk Assessment
• Risk Factors
• Sex Factors
• Treatment Outcome