Angioplasty: stenting: fewer cardiac events occurred on clopidogrel and aspirin than ticlopidine and aspirin

Clinical bottom line (level 2a)

  1. Patients undergoing coronary artery stenting who receive clopidogrel and aspirin compared with ticlopidine and aspirin are less likely to have a major cardiac adverse event (NNT = 91 at 30 days) , or die (NNT = 210 at 30 days) .
Bhatt et al: J Am Coll Cardiol 2002; 39 : 9-14
Expires March 2004

The study

Systematic review of all prospective studies of
  • Patients: undergoing coronary artery stenting
  • Intervention: clopidogrel and aspirin compared with ticlopidine and aspirin
  • Outcome: major adverse cardiac events (death, myocardial infarction, target vessle revascularisation or subacute stent thrombosis), death

    Articles found in English using Medline, to December 2000 (search terms: clopidogrel, aspirin and stents ) and searching relevant abstracts and presentations from the annual meetings of 4 major cardiology associations in 1999 and 2000

    Selection criteria: not reported
    Appraisal criteria: not reported: data from abstracts was confirmed with the author
    Articles excluded if: not reported

    3 RCTs and 7 single-centre registries found involving 13955 patients
    Heterogeneity was noted between the results from the RCTs and the registries; odds ratios were adjusted to take this into account.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    major cardiac adverse events 30 days /
    (4.04%)    		 0.72
    (0.59 to 0.89)     		90
    (62 to 230)
    death 30 days /
    (1.09%)    		 0.55
    (0.37 to 0.82)     		210
    (150 to 510)

    Comments

    1. By limiting the search to English language papers important articles may have been missed.
    2. Clopidogrel was not found to be significantly better than ticlopidine when only the RCTs were combined (OR: 0.90: 95% CI: 0.57 to 1.44).
    3. The effects on neutropenia were not reported.

    Citation

    1. Bhatt DL, Bertrand ME, Berger PB, et al: meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting. J Am Coll Cardiol 2002; 39 : 9-14
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, March 2002
    Reviewer:

    Clinical Question.
    Patient coronary artery stenting
    Intervention or Exposure clopidogrel and aspirin
    Comparison ticlopidine and aspirin
    Outcome death, myocardial infarction, revascularisation
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