Mohammad Saifur Rohman, Yeni Purnamasari, Muhammad Ilmawan, Bagus Aulia Mahdi, Fredo Tamara, Aditya Indra Mahendra, Mazen Mazen, Teuku Heriansyah, Muhammad Yamin, Budi Susetio Pikir, Jonny Karunia Fajar
Background: There is controversy among physicians regarding the use of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients treated with coronary artery bypass grafting (CABG). Moreover, the evidence of previous studies about this topic remained inconclusive. This study aimed to perform a meta-analysis concerning the relation between the risk of major bleeding and the use of different DAPT (clopidogrel or ticagrelor) in ACS patients treated with CABG. Methods: A meta-analysis was conducted during March to October 2019. Searches were carried out in Pubmed, Embase, Cochrane, and Web of Science. The predictor covariate in our present study was DAPT (clopidogrel or ticagrelor), and the outcome measure was the risk of major bleeding. Sub-group analysis was also performed, where data were classified into pre- and post-CABG. Furthermore, to determine the correlation and effect estimation, data were analyzed using fixed or random effect model. Results: A total of 13 studies consisting 34,015 patients treated with clopidogrel and 32,661 patients treated with ticagrelor was included in our study. Our pooled calculation revealed that the incidence of major bleeding was not different significantly between clopidogrel and ticagrelor. In pre- and post-CABG sub-groups, our results also found no significant difference in major bleeding incidence between clopidogrel and ticagrelor groups. Conclusions: Our meta-analysis clarifies that clopidogrel, compared to ticagrelor, or vice versa, is not associated with the risk of major bleeding in ACS patients treated with CABG. Copyright: © 2020 Rohman MS et al.
Brawijaya Cardiovascular Research Center, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, 65145, East Java, Indonesia; Faculty of Medicine, Universitas Brawijaya, Malang, 65145, East Java, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, East Java, Indonesia; Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, 65145, East Java, Indonesia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Aceh, Indonesia; Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, 16424, Jakarta, Indonesia; Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, 60115, East Java, Indonesia
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