Platelet inhibition and clinical outcomes of low dose ticagrelor in patients with coronary artery disease: a meta-analysis of randomized controlled trials

Abstract Background Although current guidelines recommend ticagrelor 90 mg twice daily in ACS patients for 12 months and 60 mg twice daily in stable patients 1 to 3 years after MI with additional high-risk features, the bleeding complication was actually higher than clopidogrel. This meta-analysis was performed to assess the platelet inhibition and clinical outcomes of low dose ticagrelor in patients with CAD. Methods Medline, EMBASE and Cochrane Databases were systematically searched from inception to March, 2021 for randomized controlled trials (RCTs) comparing low dose ticagrelor with standard dose clopidogrel or standard dose ticagrelor in patients with CAD. Pooled estimates were calculated using fixed-effects or random-effects model as appropriate. Results 15 RCTs that included 15357 patients were identified. Low dose ticagrelor had no statistical differences of the risks of MACE and major bleeding compared with standard dose ticagrelor and standard dose clopidogrel (RR 0.98, 95%CI 0.87 − 1.11, P = 0.80; RR 1.35, 95%CI 0.46 − 4.00, P = 0.59; RR 0.86, 95%CI 0.68 − 1.10, P = 0.23; RR 1.46, 95%CI 0.45 − 4.76, P = 0.53, respectively). Compared with standard dose clopidogrel, low dose ticagrelor showed significantly lower platelet reaction units (PRU) (MD -118.48, 95%CI -144.33−-92.63, P ༜0.00001), rates of high on-treatment platelet reactivity (HTPR) (RR 0.10, 95%CI 0.04 − 0.21, P ༜ 0.00001) and minor or minimal bleeding (RR 0.73, 95%CI 0.55 − 0.96, P = 0.03), but increased the incidence of dyspnea (RR 6.48, 95%CI 1.78 − 23.54, P = 0.005). Compared with standard dose ticagrelor, low dose ticagrelor showed significantly higher PRU (MD 15.45, 95%CI 5.45 − 25.44, P = 0.002) and risk of dyspnea (RR 0.81, 95%CI 0.75 − 0.88, P ༜ 0.00001), but similar rates of HTPR (RR 1.63, 95%CI 0.40 − 6.70, P = 0.50) and minor or minimal bleeding (RR 1.36, 95%CI 0.78 − 2.38, P = 0.28). Conclusion Low dose ticagrelor may provide an additional choice for secondary prevention in CAD patients. However, the specific dose of ticagrelor should be selected according to the patients’ clinical characteristics.

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Effect of hypocaloric versus standard enteral feeding on clinical outcomes in critically ill adults – A meta-analysis of randomized controlled trials with trial sequential analysis

Medicina Intensiva ◽

10.1016/j.medin.2019.10.003 ◽

2019 ◽

Author(s):

X. Zhou ◽

H. Fang ◽

C. Hu ◽

J. Xu ◽

H. Wang ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Clinical Outcomes ◽

Enteral Feeding ◽

Sequential Analysis ◽

Meta Analysis ◽

Trial Sequential Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Critically Ill Adults ◽

Ill Adults

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Mortality, viral clearance, and other clinical outcomes of hydroxychloroquine in COVID‐19 Patients: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Clinical and Translational Science ◽

10.1111/cts.13001 ◽

2021 ◽

Author(s):

Zakariya Kashour ◽

Tarek Kashour ◽

Danielle Gerberi ◽

Imad M. Tleyjeh

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Clinical Outcomes ◽

Meta Analysis ◽

Viral Clearance ◽

Controlled Trials ◽

Randomized Controlled

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Systematic Review and Meta-analysis of Adverse Events of Low-dose Aspirin and Clopidogrel in Randomized Controlled Trials

The American Journal of Medicine ◽

10.1016/j.amjmed.2005.10.039 ◽

2006 ◽

Vol 119 (8) ◽

pp. 624-638 ◽

Cited By ~ 263

Author(s):

Kenneth R. McQuaid ◽

Loren Laine

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Randomized Controlled Trials ◽

Low Dose ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Dose Aspirin ◽

Low Dose Aspirin

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Poly(ADP-Ribose) Polymerase Inhibitors (PARPi) for Patients With Advanced Breast Cancer: a Meta-analysis of Randomized Controlled Trials

10.21203/rs.3.rs-48500/v1 ◽

2020 ◽

Author(s):

YongCheng Su ◽

XiaoGang Zheng

Keyword(s):

Breast Cancer ◽

Randomized Controlled Trials ◽

Fixed Effects ◽

Meta Analysis ◽

Parp Inhibitors ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Increased Risk ◽

Grade 3

Abstract BACKGROUND: Poly(ADP–ribose) polymerase (PARP) inhibitors are new class of drugs that are currently being studied in several malignancies. However, datas about the efficacy and safety of the PARP inhibitors are limited. Therefore, we conducted a meta-analysis of randomized controlled trials (RCT) in patients with breast cancer.METHODS: Pubmed/Medline, Embase, Cochrane Library, and abstracts presented at the annual meeting of the American Society of Clinical Oncology (ASCO) were searched for articles published from 2000 to June 2018.Summary incidences and the RR, HR with 95% confidence intervals, were calculated by using a random-effects or fixed-effects model.RESULTS: The summary HR indicated PARPi was not associated with OS (HR=0.83, 95%CI 0.66–1.06, Z=1.49, P=0.14), while it could significantly improve PFS ande time to deterioration (TTD) of global health status/quality of life(GHS/QoL) as compared with traditional standard therapy, the HR was 0.60(95%CI 0.50-0.72; Z=5.52, P＜0.00001) and 0.4 (95%CI 0.29–0.54,z=5.80 ,p=0.000),respectively.The RR of grade 3 or more anemia ,fatigue and headache was 3.02 (95% CI, 0.69–13.17;p = 0.14,,I2=90%),0.77 (95%CI, 0.34–1.73;p=0.52,I2=7%) and 1.13 (95% CI,0.30–4.18;p=0.86,I2=0%),respectively.CONCLUSION: The findings of this meta-analysis showed that PARPi has no significant effect on OS, while it could significantly improve in PFS and TTD of GHS/QoL for patients with advanced or metastatic breast cancer.Furthermore,our findings also demonstrated that the PARPi treatment is connected with an increased risk of grade 3 or more anemia adverse events.

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