Systematic Review of the Efficacy and Safety of Ticagrelor Versus Clopidogrel in CYP2C19 Loss-of-function Carriers with Mild Ischemic Stroke or Transient Ischemic Attack
10.13748/j.cnki.issn1007-7693.20222361
- VernacularTitle:替格瑞洛对比氯吡格雷治疗携带CYP2C19功能缺失等位基因的轻度缺血性卒中或短暂性脑缺血发作患者有效性和安全性的系统评价
- Author:
Yu LI
1
;
Huaisen WANG
1
;
Xiaojun FENG
2
;
Huihui FAN
1
;
Tianlu SHI
2
Author Information
1. Department of Pharmacy, Taihe County People's Hospital of Anhui Province/Taihe Hospital Affiliated to Wannan Medical College, Fuyang 236600, China
2. Department of Pharmacy, The First Affiliated Hospital of University of Science and Technology of China/Anhui Provincial Hospital, Hefei 230001, China
- Publication Type:Journal Article
- Keywords:
CYP2C19；loss-of-function allele；mild ischemic stroke ； transient ischemic attack； ticagrelor；clopidogrel； efficacy ；safety
- From:
Chinese Journal of Modern Applied Pharmacy
2024;41(5):678-683
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE :To systematically review the efficacy and safety of ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with mild ischemic stroke or transient ischemic attack(TIA).
METHODS
Databases such as PubMed, Embase, the Cochrane Library, CNKI, and Wanfang were systematically searched, and the search period was from database establishment to June 2022. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of the included studies. Meta-analysis was performed using RevMan 5.3 software.
RESULTS
A total of 2 studies with 7 087 patients were included. Compared with clopidogrel, ticagrelor reduced the incidence of stroke[RR=0.78, 95%CI(0.66−0.93), I2=0%, P=0.007] and vascular event[RR=0.78, 95%CI(0.66−0.91), I2=0%, P=0.002] in patients with mild ischemic stroke or TIA carrying the CYP2C19 loss-of-function allele. The incidence of any bleeding[HR=2.18, 95%CI(1.66−2.85)] and minor bleeding[HR=2.41, 95%CI (1.81−3.20)] in the ticagrelor-aspirin group was higher than that in the clopidogrel-aspirin group, and dyspnea (1.2% vs 0.2%, P<0.001) and arrhythmias(1.7% vs 0.8%, P=0.001) were more common in the ticagrelor-aspirin group than in the clopidogrel-aspirin group. There was no significant difference in the incidence of severe bleeding between the two groups.
CONCLUSION
Compared with clopidogrel, ticagrelor reduces the incidence of stroke and vascular events in patients with mild ischemic stroke or TIA carrying the CYP2C19 loss-of-function allele, and did not increase the risk of severe bleeding. However, the ticagrelor group had a higher incidence of minor bleeding, dyspnea and arrhythmias.
