Prasugrel Versus 150mg Clopidogrel In Patients With High On Treatment Platelet Reactivity :A Meta Analysis

ObjectiveTo compare the efficacy and safety of prasugrel and 150 mg clopidogrel in patients with high on-treatment platelet reactivity.MethodsDatabase including PubMed,EMBASE, the Cochrane Library(Issue 3, 2016), CBM, WanFang Data, VIP and CNKI were searched for randomized controlled trials on high on-treatment platelet reactivity. from inception to February, 2016 Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The efficacy and safety of prasugrel and 150 mg clopidogrel were compared in patients with high on-treatment platelet reactivity through RevMan 5.3.ResultsA total of five randomized controlled trials(including 281patients)matched the inclusion criteria of this study. In efficacy analysis,prasugrel exhibited greater platelet inhibition(SMD=-0.68,95%CI [-0.93~-0.44],p﹤ 0.00001) and lower high on-treatment platelet reactivity rates(OR=0.21,95%CI [0.11~0.43],p﹤0.0001)than 150 mg clopidogrel. In safety analysis,prasugrel showed no increase in overall bleeding events( OR=0.98, 95%CI[0.24~4.04],p=0.98) and the predicted risk for cardiovascular events was not heterogeneous.ConclusionCompared to 150 mg clopidogrel,prasugrel is a better choice in high on-treatment platelet reactivity patients with improved efficacy and without increasing overall bleeding risk.