Efficacy And Safety Of Prasugrel In Patients With Acute Coronary Syndrome:A Meta-Analysis Of Randomized Controlled Trials

Objective:Evaluating the efficacy and safety of Prasugrel（PRA）in treatment of patients with acute coronary syndrome（ACS）.Methods:By searching the online databases of PubMed,Web of Science,etc.,to collect randomized controlled trials（RCTs）,published before the end of March 2018,concerning the comparison of Prasugrel and other P2Y₁₂receptor antagonists about efficacy and safety in treatment of patients with ACS,the author extracted the data from these RCTs and performed statistical analysis through RevMan 5.3 software.Results:Seven RCTs were included in this analysis.The results of this meta-analysis found that,compared with clopidogrel or ticagrelor,prasugrel was with a lower risk of major adverse cardiac events（MACE）（RR=0.83;95%CI:0.78-0.89;P<0.00001）,but with a significantly higher incidence rate of bleeding events（RR=1.27;95%CI:1.11-1.45;P=0.0005）.Besides,there was no obvious difference in all-cause mortality（RR=0.97;95%CI:0.85-1.10;P=0.60）and cardiovascular mortality（RR=0.92;95%CI:0.79-1.07;P=0.28）.The results of subgroup analysis show that,compared with clopidogrel,the risk of MACE in prasugrel was significantly reduced（RR=0.82;95%CI:0.76-0.88;P<0.00001）,and the incidence rate of bleeding events was clearly higher（RR=1.36;95%CI:1.17-1.58;P<0.0001）.However,there was no significant difference in the risk of MACE（RR=1.11;95%CI:0.78-1.6）and bleeding events（RR=0.96;95%CI:0.72-1.28）when compared with ticagrelor.Conclusion:When compared with clopidogrel in treatment of patients with ACS,prasugrel was with a significantly lower risk of MACE,but a clearly higher incidence rate of bleeding events,no obvious difference in All-cause mortality and cardiovascular mortality.But prasugrel and ticagrelor have the same efficacy and safety.