Comparison between prasugrel and clopidogrel used as antiplatelet medication for endovascular treatment of unruptured intracranial aneurysms. A meta-analysis - 28/02/20
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Resumen |
Background |
Clopidogrel is routinely used to decrease ischemic complications during neurointerventional procedures. However, the efficacy may be limited by the antiplatelet resistance.
Purpose |
To analyze the efficacy of prasugrel (PS) compared to clopidogrel (CP) in the cerebrovascular field.
Data sources |
A systematic search of two large databases was performed for studies published from 2000 to 2018.
Study selection |
According to PRISMA guidelines, we included studies reporting treatment-related outcomes of patients undergoing neurointerventional procedures under PS, and studies comparing PS and CP.
Data analysis |
Random-effects meta-analysis was used to pool the following: overall rate of complications, ischemic and hemorrhagic events, influence of the dose of PS.
Data synthesis |
Including 7 studies, 682 and 672 unruptured intracranial aneurysms were treated under PS (cases) and CP (controls), respectively. Low-dose (20mg/5mg) (loading and maintenance doses) of PS compared with the standard dose of CP (300mg/75mg) showed a significant reduction of the complication rate (OR=0.36, 95% CI=0.17–74, P=0.006, I2=0%). Overall, ischemic complication rate was significantly higher among the CP group (40/672=6%, 95% CI=3%–13%, I2=83% vs 16/682=2%, 95% CI=1%–5%, I2=73%, P=0.03). Low and high loading doses of PS were associated with 0.6% (5/535, 95% CI=0.1%–1.6%, I2=0%) and 9.3% (13/147, 95% CI=0.2%–18%, I2=60%) of intra-periprocedural hemorrhages, respectively (P=0.001), whereas low and high maintenance doses of PS were associated with 0% (0/433) and 0.9% (2/249, 95% CI=0.3%–2%, I2=0%) of delayed hemorrhagic events, respectively (P=0.001).
Limitations |
Retrospective series and heterogeneous endovascular treatments.
Conclusions |
In our study, low-dose of prasugrel, compared with clopidogrel premedication, is associated with an effective reduction of the ischemic events with an acceptable rate of hemorrhagic complications.
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Vol 47 - N° 2
P. 102-103 - mars 2020 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
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