Platelet inhibition before elective percutaneous coronary intervention reduces the risk of ischemic complications in patients. Recently, new P2Y12 inhibitors have been preferred over clopidogrel for acute coronary syndrome patients. The comparative safety and efficacy of P2Y12 over clopidogrel in elective PCI is yet unknown. A systematic review of randomized controlled trials (RCT) was conducted up to June 2021. Safety and effectiveness of loading strategies of different loading strategies of P2Y12 inhibitors before elective PCI was conducted. The endpoint of the study:
- Major bleeding,
- Overall mortality,
- Rates of myocardial infarction (MI).
With the help of random effects, the frequentist approach performed a meta-analysis of the network using R software. Researchers used 5194 patients for five trials, including the current analysis. Stroke, revascularization, MI, prasugrel had a favourable trend for ischemic outcomes. Clopidogrel is most effective for major bleeding and all-cause mortality. These trends were significant due to a lack of power for each outcome.
Researchers conclude that although ticagrelor and prasugrel are more potent antiplatelet agents, their effects on preventing stroke and MI are minimal. Furthermore, in comparison to clopidogrel, they showed little impact on overall mortality and bleeding rate.