Thromb Haemost 2019; 119(06): 1000-1020
DOI: 10.1055/s-0039-1683421
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Optimal Timing of P2Y12 Inhibitor Loading in Patients Undergoing PCI: A Meta-Analysis

Anna Komosa
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Maciej Lesiak
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Zbigniew Krasiński
2  Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
,
Marek Grygier
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Andrzej Siniawski
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Włodzimierz Skorupski
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Anna Olasińska-Wiśniewska
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Małgorzata Pyda
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Aleksander Araszkiewicz
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Przemysław Mitkowski
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Stefan Grajek
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Tatiana Mularek-Kubzdela
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
,
Christian Hengstenberg
3  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Jolanta M. Siller-Matula
1  1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
3  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Funding None.
Further Information

Publication History

27 November 2018

25 January 2019

Publication Date:
27 March 2019 (online)

Abstract

Background and Aim The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI).

Methods This is a systematic review and meta-analysis. Randomized controlled trials and non-randomized studies were included. Outcomes evaluated were combined major adverse cardiovascular events (MACEs), myocardial infarction (MI), target vessel revascularization, death and bleeding complications. Summary estimates of the relative risks with therapy were calculated.

Results Twenty-three studies met the selection criteria and included 60,907 patients. Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction (RRR) of MACE (95% confidence interval [CI] = 0.68–0.89; p < 0.001). Early clopidogrel loading was associated with a 25% RRR of MACE (95% CI = 0.65–0.85; p < 0.001), a 30% RRR of MI (95% CI = 0.6–0.82; p < 0.0001) and 25% RRR of death (95% CI = 0.64–0.87; p = 0.0002), without an impact on major bleedings. In ST-elevation myocardial infarction as well as non-ST elevation acute coronary syndrome (NSTE-ACS), early clopidogrel loading resulted in 35 and 22% RRR in 30 days MACE (p < 0.001), respectively, with no impact in elective PCI. Whereas early loading with prasugrel and ticagrelor did not improve ischaemic outcomes, prasugrel administered early increased bleeding risks in NSTE-ACS.

Conclusion Early clopidogrel loading is associated with a better efficacy and similar safety, whereas timing of ticagrelor or prasugrel loading had no effects on ischaemic events.