Comparison of the risk for pneumonia in antiplatelet therapy with clopidogrel and ticagrelor: a meta-analysis
10.3760/cma.j.cn114015-20230110-00003
- VernacularTitle:氯吡格雷和替格瑞洛抗血小板治疗中肺炎发生风险比较的meta分析
- Author:
Zhifang RAO
1
;
Jing TU
1
;
Zhenling CHENG
1
Author Information
1. 华润武钢总医院药学部，武汉 430080
- Publication Type:Journal Article
- Keywords:
Platelet aggregation inhibitors;
Pneumonia;
Meta-analysis;
Clopidogrel;
Tica- grelor;
Adverse drug reactions
- From:
Adverse Drug Reactions Journal
2023;25(11):676-682
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the risk for pneumonia in antiplatelet therapy with clopidogrel and ticagrelor.Methods:The relevant databases including PubMed, Embase, Cochrane Library, CBM, CNKI, and Wanfang Med (up to March 1, 2022) were searched. The randomized controlled trials (RCTs) of clopidogrel and ticagrelor (trial group or control group to each other) in the treatment of coronary atherosclerotic heart disease were collected. The Cochrane collaboration risk of bias assessment tool was used to evaluate the methodological quality of the RCTs. RevMan 5.4 software was used for meta-analysis to compare the risk of pneumonia in patients between 2 groups. The effect sizes were the risk ratio ( RR) and its 95% confidence interval ( CI). Results:A total of 5 RCTs were enrolled in the analysis. The methodological quality evaluation results showed that 2 RCTs were with low risk of bias and the others were high. In the 5 RCTs, 36 401 patients were involved, of which 18 724 received the therapy for acute coronary syndrome, 13 842 for peripheral artery disease, 3 799 for myocardial infarct, and 36 for coma survivor with cardiac arrest. The meta-analysis results showed that the incidence of pneumonia were 1.5% (271/18 174) and 1.2% (217/18 227) in patients receiving clopidogrel and ticagrelor, respectively; the risk of pneumonia in ticagrelor-treated patients was relatively lower, and the difference was statistically significant ( RR=0.80, 95% CI: 0.67-0.95, P=0.01). Subgroup analysis showed that the risk for pneumonia was similar in patients between the 2 groups when they received short-term (several days) medication ( P=0.26), while the risk was relatively lower in ticagrelor-treated patients compared with that in clopidogrel-treated patients when the therapeutical time was more than 12 months ( RR=0.80, 95% CI: 0.67-0.96, P=0.02). And also, in the combination therapy with aspirin, the risk of pneumonia was lower in ticagrelor-treated patients than that in clopidogrel-treated patients ( RR=0.74, 95% CI: 0.56-0.98, P=0.03). Conclusion:Compared with clopidogrel, the risk for pneumonia was relatively lower in ticagrelor treatment than that in clopidogrel treatment.
