Highlights
- •A reduced efficacy of clopidogrel has been reported in subjects with diabetes.
- •The definitions of “efficacy” have relied on ex vivo measurement of platelet function.
- •RCTs data do not suggest a different efficacy of clopidogrel in diabetes.
- •Limited data are available for other P2Y12 inhibitors in other clinical subgroups.
Abstract
Objective
The efficacy of antiplatelet drugs may differ in specific patient subgroups. We aimed
to assess the efficacy and safety of the P2Y12 inhibitors clopidogrel, ticlopidine, prasugrel, ticagrelor, and cangrelor according
to diabetes status, age, gender, body mass index, and body weight.
Methods
Randomized clinical trials (RCTs) of P2Y12 inhibitors reporting information on cardiovascular disease (defined as myocardial
infarction, stroke, or cardiovascular death) and bleeding (defined as any bleeding)
events among the subgroups diabetes and non-diabetes, age ≥65 and <65 year-old, men
and women, body mass index ≥30 and <30 kg/m2, and body weight ≥60 and <60 kg, were identified in Medline, Embase, Web of Science,
and Cochrane Library on August 31st, 2014. For each inhibitor, random-effects meta-analyses
were used to estimate the ratio of relative risks (rRR) for cardiovascular and bleeding
events among patient subgroups.
Results
Twenty distinct RCTs (233 285 participants, 21 323 cardiovascular and 5183 bleeding
events) were identified. Cardiovascular risk reduction with clopidogrel did not significantly
differ according to diabetes (rRR: 1.04; 95% CI: 0.95 to 1.13; p = 0.395), age (0.98;
0.88 to 1.09; p = 0.347), gender (0.97; 0.90 to 1.04; p = 0.382), or body mass index
(1.11, 0.95 to 1.31; p = 0.191). Results for other inhibitors were comparable, although
available data were sparse. Limited data on bleeding events were available.
Conclusion
Data from RCTs did not show a different cardiovascular efficacy of clopidogrel in
diabetes mellitus and other clinically relevant subgroups. Limited information was
available on the efficacy and safety of other P2Y12 inhibitors in specific subgroups.
Keywords
Abbreviations:
ASA (acetylsalicylic acid), BMI (body mass index), RCTs (randomized clinical trials), RR (relative risk), rRR (ratio of relative risk), T2DM (type 2 diabetes mellitus)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 16, 2015
Accepted:
April 13,
2015
Received in revised form:
April 8,
2015
Received:
March 20,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
