The Efficacy And Safety Of Ticagrelor Or Clopidogrel For Antithrombotics In PCI Patients Were Compared Based On Meta-analysis

Objective:Meta-analysis and statistical methods are used to systematically evaluate the safety and effectiveness of ticagrelor or clopidogrel in antithrombotic treatment in patients with Percutaneous Coronary Intervention(PCI),which is an antithrombotic drug for clinicians in PCI patients Variety selection provides evidence-based reference.Methods:Search including Pub Med,Chinese Journal Full-text Database(CNKI),VIP and Wan Fang Data,Cochrane Library and other databases.Select "January 2010 to January 2021" as the search time interval to collect ticagrelor and clopidogrel Related research literature of randomized controlled trials(RCT).By setting uniform inclusion and exclusion criteria for research projects,and screening the searched database documents one by one according to the criteria,the quality of the included literature is finally evaluated using the Cochrane Manual 5.1.0 version of the randomized controlled trial bias risk assessment tool,and the final inclusion is The result data of all literatures were studied using Rev Man5.3 and stata15.0 software for Meta statistical analysis.Results:According to the inclusion and exclusion criteria,a total of 16 research articles that meet the requirements were screened.Collect the data of the included 16 articles,and use Rev Man5.3 and stata 15.0 software for statistical analysis of the two sets of data of PCI patients after applying ticagrelor and clopidogrel:1.Effectiveness indicators:all-cause death [RR=0.83,95%CI(0.75～0.91),P=0.0001<0.05],stroke events[RR=0.84,95% CI(0.71～0.98),P=0.03<0.05],myocardial infarction events[RR=0.79,95%CI(0.72～0.87),P<0.00001],adverse cardiac events [RR=0.69,95%CI(0.50～0.97),P=0.03<0.05],Stent thrombosis events [RR=0.61,95%CI(0.42～0.89),P=0.01<0.05],The difference in the above indicator were statistically significant.The egger test method used evaluate the publication bias of the all-cause mortalityindex.The results showed that the P>|t| value of the research index was 0.908,indicating that the risk of publication bias in the literature is small.2.Safety evaluation indicators: total bleeding events [RR=1.14,95%CI(1.01～1.29),P=0.03<0.05],major bleeding events[RR=1.22,95%CI(1.08～1.37),P=0.001<0.05],minor bleeding events [RR=1.35,95%CI(1.09～1.66),P=0.005<0.05],The differences in the above indicators were statistically significant,and dyspnea events [1.71,95%CI(0.97～3.03),P=0.07>0.05],bradycardia events[RR=1.01,95%CI(0.89～1.16),P=0.86>0.05],the difference was not statistically significant.The Egger test was used to evaluate the publication bias of the total bleeding event rate index.The results showed that the P>|t| value of the research index was 0.129,indicating that the risk of publication bias in the literature is small.Conclusion:Compared with clopidogrel,the effectiveness of ticagrelor in PCI patients:all-cause death,stroke,myocardial infarction,and cardiac adverse event indicators have a relatively low risk of occurrence;but in terms of safety: total bleeding The risk of occurrence of,major bleeding,and minor bleeding events is relatively high,and there is no significant difference in the risk of dyspnea and bradycardia events.Based on the above results,for PCI patients with normal coagulation function,it is recommended to choose ticagrelor for antithrombotic therapy in clinical practice,but at the same time,during the application process,closely monitor the changes of patients’ coagulation indicators to prevent bleeding events.For patients with significant risk of bleeding,such as patients with coagulation dysfunction or abnormal coagulation indicators,clopidogrel is recommended.