Adjusted indirect meta-analysis of Aspirin plus Warfarin at international normalized ratios 2 to 3 versus Aspirin plus Clopidogrel after acute coronary syndromes
| Autor: | Italo Porto, Graziana Trotta, Filippo Crea, Felicita Andreotti, Giuseppe Biondi Zoccai, Luca Testa, Pierfrancesco Agostoni |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2007 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Ticlopidine Coronary Disease Thromboembolic stroke Lower risk Risk Assessment Internal medicine medicine Humans International Normalized Ratio Myocardial infarction Stroke Randomized Controlled Trials as Topic Aspirin business.industry Warfarin Anticoagulants Syndrome medicine.disease Clopidogrel Cardiology Drug Therapy Combination Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Popis: | After acute coronary syndromes, the beneficial effect of aspirin plus clopidogrel (A+C) or aspirin plus dose-adjusted warfarin (A+W) compared with aspirin alone is well established. However, these regimens were never compared. To compare the risk-benefit profile of A+C versus A+W after acute coronary syndromes, major medical databases for randomized controlled trials comparing 1 of these combined approaches versus aspirin alone after an acute coronary syndrome (updated June 2006) were searched. Evaluated end points were major adverse events [MAEs: all-cause death, acute myocardial infarction [AMI], thromboembolic stroke, major bleeds, and overall risk of stroke [hemorrhagic or ischemic]). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for (1) A+W versus aspirin alone, (2) A+C versus aspirin alone, and (3) A+W versus A+C using adjusted indirect meta-analysis. Thirteen studies were included, totaling 69,741 patients. Ten compared A+W versus aspirin alone and 3 compared A+C versus aspirin alone. Each combined approach yielded a significantly lower risk of MAEs, albeit an increased risk of major bleeds, compared with aspirin alone. No significant difference was found for A+W versus A+C for risk of overall MAEs, death, or AMI. However, A+W versus A+C was associated with a significantly lower risk of thromboembolic stroke (OR 0.53, 95% CI 0.31 to 0.88, number needed to treat 60) and all types of stroke (OR 0.58, 95% CI 0.35 to 0.94, p=0.038), but also with increased risk of major bleeds (OR 1.9, 95% CI 1.2 to 2.8, number needed to harm 300). In conclusion, after an acute coronary syndrome, A+W and A+C are comparable in the prevention of MAEs, death, and AMI compared with aspirin alone. Allocating 100 patients to A+W (at international normalized ratio 2 to 3) with respect to A+C could prevent 17 thromboembolic strokes while causing 3 major bleeds. |
| Databáze: | OpenAIRE |
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