<h2>Pretreatment with P2Y12 inhibitors in patients with nonST-segment elevation acute coronary syndrome: A meta-analysis.</h2>

In this meta-analysis, clopidogrel pretreatment was associated with significantly lower risk of mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), death, and revascularization without increase in risk of major bleeding in nonST-segment elevation acute coronary syndrome (NSTE-ACS) patients. However, prasugrel or ticagrelor pretreatment lacked ischemic protection and caused major bleeding events.

<h2>Key Takeaway</h2>
<ul>
 <li>This meta-analysis comparing pretreatment with P2Y12 inhibitors with no pretreatment in patients with NSTE-ACS from nine studies demonstrated that: 
 <ul>
 <li>P2Y12 inhibitor pretreatment was associated with lower death from any cause without increasing the risk of major bleeding with no distinction in MI, revascularization and MACE</li>
 <li>Clopidogrel pretreatment subgroup was significantly associated with lower incidence of mortality, MACE, MI, and revascularization without increasing major bleeding</li>
 <li>Prasugrel or ticagrelor pretreatment subgroup was associated with no significant difference in mortality, MACE, MI or revascularization, whereas major bleeding events were significantly increased</li>
 <li>Lower mortality and ischemic protection were observed in non- randomized controlled trials (RCTs) vs RCTs</li>
 </ul></li>
</ul>

<h2>Why This Matters</h2>
<ul>
 <li>P2Y12 receptor inhibitor loading (300 mg clopidogrel) before percutaneous coronary intervention (PCI) is found to reduce MACE but slightly increase bleeding events 
 <ul>
 <li>However, large-scale RCTs of clopidogrel pretreatment are lacking</li>
 </ul></li>
 <li>Current RCTs for prasugrel and ticagrelor do not recommend pretreatment, as they do not reduce ischemic events but increase the risk of major bleeding.</li>
 <li>In the era of prasugrel and ticagrelor, the optimal timing of P2Y12 receptor inhibitor administration remains controversial.</li>
 <li>This meta-analysis compared pretreatment with P2Y12 inhibitors with no pretreatment in patients with NSTE-ACS.</li>
</ul>

<h2>Study Design</h2>
<ul>
 <li>This meta-analysis included trials meeting following criteria: Studies with &gt;50% of patients with NSTE-ACS; studies comparing pretreatment with P2Y12 inhibitor with no pretreatment; observational or randomized studies; studies with data on loading dose and timing of P2Y12 inhibitors were available; data reporting any data of interest, including at least any cause mortality, major bleeding</li>
 <li>Excluded trials: Ongoing and no control group studies and duplicate reports</li>
 <li>Primary efficacy and safety endpoint: Death from any cause and major bleeding</li>
 <li>Secondary endpoint: MACEs, MI and revascularization</li>
</ul>

<h2>Key Results</h2>
Characteristics of the included studies
<ul>
 <li>This meta-analysis included nine studies (2 RCTs, 2 post hoc analyses of RCTs and 5 non-RCTs).</li>
 <li>Pretreatment with prasugrel or ticagrelor was included in 2 studies, pretreatment with 3 P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor) in one study, and pretreatment with clopidogrel in 6 studies.</li>
 <li>Of the 94,506 NSTE-ACS patients enrolled, 80,272 patients were pretreated with P2Y12 inhibitor.</li>
 <li>In total 51,922 patients (55.6%) were treated with clopidogrel, and 41,389 (44.4%) patients were treated with prasugrel or ticagrelor.</li>
</ul>

Impact on primary outcomes
<ul>
 <li>Pretreatment before coronary angiography (CAG) in NSTE-ACS patients was associated with 
 <ul>
 <li>Significant lower incidence of mortality (odds ratio [OR] = 0.62, 95% confidence interval, [CI]: 0.53–0.72, P &lt;0.00001)</li>
 <li>No significant difference in the incidence of major bleeding (OR = 1.02, 95% CI: 0.80–1.30, P = 0.89)</li>
 </ul></li>
</ul>

Impact on MACE, MI, and revascularization
<ul>
 <li>No difference was noticed between the pretreatment group and no pretreatment group 
 <ul>
 <li>MACE: OR = 0.83, 95% CI: 0.68–1.01, P = 0.07</li>
 <li>MI: OR = 0.74, 95% CI: 0.54–1.00, P = 0.05</li>
 <li>Revascularization: OR = 0.82, 95% CI: 0.67–1.00, P = 0.05</li>
 </ul></li>
</ul>

Subgroup analyses:&nbsp;Prasugrel or ticagrelor vs clopidogrel
<ul>
 <li>Prasugrel or ticagrelor pretreatment was associated with: 
 <ul>
 <li>No striking differences in mortality (OR = 0.70, 95% CI: 0.31–1.59, P = 0.40), MACE, MI, and revascularization</li>
 <li>Significantly increased major bleeding events (OR = 1.67, 95% CI: 1.10–2.54, P = 0.02)</li>
 </ul></li>
 <li>Clopidogrel pretreatment was associated with lower incidence of mortality (OR = 0.61, 95% CI: 0.52–0.72, P &lt;0.0001), MACE, MI, and revascularization without increasing major bleeding.</li>
</ul>

Sensitivity analysis and reporting bias
<ul>
 <li>Results remained unchanged post excluding study with largest number of patients.</li>
 <li>No obvious heterogeneity in research results of different era* was observed.</li>
</ul>

<h2>Limitations</h2>
<ul>
 <li>Most included studies were non RCTs with inherent biases and confusions</li>
 <li>Obvious heterogeneity in MI and MACE was observed</li>
 <li>Pretreatment definition as well as the time from P2Y12 inhibitor load to PCI differed in various studies.</li>
 <li>The analysis of the potency of P2Y12 was limited due to a lack of data</li>
</ul>
*The relevant research results before (before 2011) and after the change (after 2011) For additional details, please refer to the source publication,&nbsp;<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9259160/" target="_blank">Yan L et al.</a>

Reference

Ticagrelor vs Clopidogrel in high bleeding risk patients with ACS

OTHER-CARDIOLOGY-TOPICS

CARDIOLOGY

To read the full content, activate your Sanofi Campus account. Please confirm your email address in the email you received.

If you didn't receive our first email at {email} to confirm your account you can request a new one below. If you don't see it, you may need to check your spam folder.

This information will only be used to validate your account and will not be distributed.

title

Before starting exploring, we can suggest you specific and relevant content

Title

This website is for healthcare professionals only.

Welcome to BP Sanofi Campus

Create new password

To offer you a personalised experience, you must

Your profile is incomplete

The ADCT gives a measure of how controlled the eczema is. Answer these 6 simple questions with your patient to find the ADCT score. It will indicate proper course of action.

Atopic dermatitis, a type of eczema, may be affecting your Patient's life in more ways than you know.

Take the Atopic Dermatitis Control Test (ADCT)

Enjoy more exclusive content{newline}by <a>registering today</a>

Already have an account? <a>Sign in here</a>

Best practices on optimising patient care

Get a customised view of the topics that you're interested in, along with the ability to save content to watch or read at a later date.

Unlimited access to premier content, white papers, case studies, research papers, webinars, training, and up-to-date scientific medical resources.

Personalised content based on your areas of interest

Connect and stay up-to-date with peers in your area of speciality and topics of interest through free events and leadership forums.

Please sign in to continue and read the full article

Please sign up to continue reading the full article.

We respect your privacy and will not share your information with any 3rd parties.

Topical guides written specifically for patients

Unlimited access to the latest patient guide guides and resources. Share content with your patients with easy-to-use online tools.

Please complete your profile to read the content.

Your profile is not validated yet. Please verify your inbox.

Restricted Access

We can't find the page you're looking for

You are going to a website that is not operated by Sanofi. Sanofi has no control over the content or availability of linked sites or resources, and accepts no liability or responsibility for them or for any loss or damage that may arise from your use of them. Please ensure that you read the legal and privacy policy sections of any third-party site to which you link.

You are about to leave Sanofi Campus website.

You are now leaving this site to visit a partner website.

Thank you for visiting COPD Sanofi Campus.

Welcome to COPD Sanofi Campus.

Welcome to COPD Sanofi Campus

Welcome to CSU Sanofi Campus

Please refresh the page to access the content

Sorry, something went wrong

We're usually a treasure chest of knowledge, but we couldn't find what you're looking for.

We were unable to find what you're searching for

You are about to leave Campus.sanofi/uk.

Images from <a>iStockphoto.com</a>, Fotolia.de, <c>gettyimages.de</c>, <d>pexels.com</d> and <e>photocase.de</e> were used for our websites.

Thank you for registering. Before we get started, we need to confirm your email address to ensure that we have the correct information.

Please follow these steps to complete your registration:

Would you like to receive future text messages about Beyfortus updates?

Sanofi is here to help support your patients, their families, and caregivers. For more information regarding Beyfortus® (nirsevimab-alip), call <a.callPhoneNumberBeyfortus>1-855-BEYFORTUS (1-855-239-3678)</a.callPhoneNumberBeyfortus> or sign up below to receive the latest updates via email or text. All fields are required.

Would you like to learn more about Beyfortus® (nirsevimab-alip) 50 mg and 100 mg injection? Leave us your contact details, and a Sanofi representative will be in touch. All fields are required.

Would you also like to receive future messages and updates about Beyfortus?

Do you want to participate in the Beyfortus Reservation Program?

What information are you interested in learning more about? (Optional)

Are you enrolled in CENRIFKI REMS?

Request a visit from your local ALPROLIX representative to learn more. Call <a.callPhoneNumberAltuviiio>1-800-745-4447</a.callPhoneNumberAltuviiio>, Option 5, or complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Request a visit from your local ALTUVIIIO representative to learn more. Call <a.callPhoneNumberAltuviiio>1-800-745-4447</a.callPhoneNumberAltuviiio>, Option 5, or complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Request a visit from your local QFITLIA representative to learn more. Call <a.callPhoneNumberAltuviiio>1-800-745-4447</a.callPhoneNumberAltuviiio>, Option 5, or complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Sign up to schedule an office visit with your ALPROLIX® Representative or receive updates about ALPROLIX. Please complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required.

Sign up to schedule an office visit with your local Sanofi representative and/or to receive updates about Qfitlia. Please complete the form below. The information you provide will be maintained in accordance with our <a.usPrivacyPolicy>Privacy Policy</a.usPrivacyPolicy>. All fields are required (unless otherwise specified).

All fields are required. (unless otherwise specified)

This site is intended for healthcare professionals only and contains information on Sanofi medicines, educational resources and more. Please click the appropriate button below. By entering this site, you are confirming that you are a healthcare professional. This site contains promotional information. Please note that some of the content on the website is only relevant for HCPs.

Welcome to Sanofi Campus

Welcome to ITP Sanofi Campus

This content is only available to registered users. Please sign in or register to view this content.

Please Sign In

Email verification

You're seeing a preview of the portal. Clear your cookies (by closing your browser window for example) to go back to public mode.

We've updated our privacy notice to better protect your data and enhance your experience. Please take a moment to review the changes by <privacyNewTab>clicking here</privacyNewTab>. Your privacy matters for us. Please click on continue to confirm you have read the new privacy notice.

Privacy Notice Update

Communication consent

My consents

Password

Confirm password

{resultsCount, plural, one {result} other {results}}

Please log in to access to the results

You need to sign-in to your account in order to access medical content.

Please Log In

To access the results, please register in under 1 minute

You are now leaving the Sanofi content section of our site and entering the external medical bibliographic search content section.

You are entering to the External Scientific Content Site

You are now leaving the external medical bibliographic search section of our site and entering the Sanofi content section.

Other Cardiology Topics

Latest Articles

Ticagrelor vs Clopidogrel in high bleeding risk patients with ACS