Drug class review: Newer antiplatelet agents : final update 2 report

PURPOSE: We compared the effectiveness and harms of clopidogrel, ticlopidine, extended-release dipyridamole and aspirin and prasugrel in adults with acute coronary syndromes or coronary revascularization (stenting, bypass grafting), ischemic stroke or transient ischemic attack, or symptomatic periph...

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Main Author: Ketchum, Kathy
Corporate Authors: Drug Effectiveness Review Project, Oregon Health & Science University Evidence-based Practice Center, Oregon Health & Science University
Format: eBook
Language:English
Published: Portland, Or. Oregon Health & Science University c2011, 2011
Series:Drug class reviews
Subjects:
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:PURPOSE: We compared the effectiveness and harms of clopidogrel, ticlopidine, extended-release dipyridamole and aspirin and prasugrel in adults with acute coronary syndromes or coronary revascularization (stenting, bypass grafting), ischemic stroke or transient ischemic attack, or symptomatic peripheral vascular disease. DATA SOURCES: We searched Ovid MEDLINE(r), the Cochrane Database of Systematic Reviews(r), and the Cochrane Central Register of Controlled Trials(r) and Database of Abstracts of Reviews of Effects through January 2011. We also hand searched reference lists, US Food and Drug Administration medical and statistical reviews, and dossiers submitted by pharmaceutical companies. REVIEW METHODS: Study selection, data abstraction, validity assessment, grading the strength of the evidence, and data synthesis were all carried out according to standard Drug Effectiveness Review Project review methods.
RESULTS AND CONCLUSIONS: High-strength evidence indicated that in coronary revascularization, prasugrel reduces target-vessel revascularization more than clopidogrel at 15 months, while moderate-strength evidence indicated that there was more major bleeding with prasugrel. Evidence was moderate strength that the use of clopidogrel for 6 months after coronary revascularization resulted in lower risk of revascularization compared with 1 month, with no increase in bleeding (moderate strength). The benefit lessened after 8 and 12 months and bleeding risk gradually increased (moderate to low strength). In patients with acute coronary syndrome who are managed medically, there was moderate-strength evidence of no significant difference in reduction of mortality out to at least 12 months, significantly fewer myocardial infarctions, and increased major bleeding between clopidogrel plus aspirin compared with aspirin alone.
Following stroke or transient ischemic attack, high-strength evidence indicated that extended-release dipyridamole plus aspirin did not meet criteria for being noninferior to clopidogrel for the primary outcome of recurrent stroke and had higher risks of major bleeding and withdrawals due to adverse events. Evidence was insufficient to draw strong conclusions about the benefit-risk ratio of using a proton pump inhibitor for any patients taking clopidogrel
Item Description:"June 2011"
Physical Description:1 online resource (1 PDF file (98 p.))