{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T16:36:11Z","timestamp":1762101371510},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Administration of a P2Y12-receptor antagonist in addition to aspirin is mandatory in patients with acute coronary syndromes (ACS) or undergoing percutaneous coronary intervention (PCI) to reduce the occurrence of thrombotic events; however, their impact on mortality and stroke is unclear. We aimed to evaluate the influence of moderate (clopidogrel) or potent (prasugrel\/ticagrelor) P2Y12-receptor inhibition on major cardiovascular outcomes among patients with ACS or undergoing PCI. Systematic literature search was performed to find randomised, controlled clinical trials comparing the clinical impact of clopidogrel with placebo or prasugrel\/ticagrelor versus clopidogrel. Outcome measures included cardiovascular death, myocardial infarction (MI), total stroke and intracranial haemorrhage (ICH). Random-effects model with Mantel-Heanszel weighting was used to pool outcomes into a meta-analysis. Four studies comparing clopidogrel with placebo and five trials comparing clopidogrel with new P2Y12-receptor inhibitors were identified including a total of 107,473 patients. Compared to placebo, clopidogrel reduced the risk of cardiovascular death (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.87\u20130.99, p=0.02), MI (OR 0.80; 95%CI 0.74\u20130.88, p&lt;0.00001) and stroke (OR 0.84; 95%CI 0.72\u20130.97, p=0.02), without influencing risk for ICH (OR 0.96;&amp; 95%CI 0.69\u20131.33, p=0.79). Treatment with prasugrel\/ticagrelor provided additional benefit over clopidogrel regarding cardiovascular mortality (OR 0.86; 95%CI 0.78\u20130.94, p=0.002) and MI (OR: 0.83; 95%CI 0.74\u20130.93, p&lt;0.001), but no advantage in stroke (OR: 1.06; 95%CI 0.88\u20131.26, p=0.55) and in ICH (OR: 1.16; 95%CI 0.75\u20131.81; p=0.49) was observed. Increased potency of P2Y12-receptor inhibition is associated with decreased risk in cardiovascular death and MI; however, this association is not true in case of stroke, where potent P2Y12-receptor antagonists have no incremental benefit over clopidogrel.<\/jats:p>","DOI":"10.1160\/th12-06-0377","type":"journal-article","created":{"date-parts":[[2012,11,30]],"date-time":"2012-11-30T03:13:30Z","timestamp":1354245210000},"page":"93-101","source":"Crossref","is-referenced-by-count":39,"title":["Impact of clopidogrel and potent P2Y12-inhibitors on mortality and stroke in patients with acute coronary syndrome or undergoing percutaneous coronary intervention"],"prefix":"10.1160","volume":"109","author":[{"given":"Andr\u00e1s","family":"Kom\u00f3csi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e1s","family":"Vorobcsuk","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor L.","family":"Serebruany","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D\u00e1niel","family":"Aradi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2017,11,27]]},"reference":[{"key":"10.1160\/TH12-06-0377-1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr236"},{"key":"10.1160\/TH12-06-0377-2","doi-asserted-by":"crossref","unstructured":"Yusuf S, Zhao F, Mehta SR, et al.; Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494-502","DOI":"10.1056\/NEJMoa010746"},{"key":"10.1160\/TH12-06-0377-3","doi-asserted-by":"crossref","unstructured":"Steinhubl SR, Berger PB, Mann JT 3rd, et al.; CREDO Investigators. Clopidogrel for the Reduction of Events During Observation.. Clopidogrel for the Reduction of Events During Observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. J Am Med Assoc 2002; 288: 2411-2420","DOI":"10.1001\/jama.288.19.2411"},{"key":"10.1160\/TH12-06-0377-4","doi-asserted-by":"crossref","unstructured":"Sabatine MS, Cannon CP, Gibson CM, et al.; CLARITY-TIMI 28 Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005; 352: 1179-1189","DOI":"10.1056\/NEJMoa050522"},{"key":"10.1160\/TH12-06-0377-5","doi-asserted-by":"crossref","unstructured":"Chen ZM, Jiang LX, Chen YP, et al.; COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1607-1621","DOI":"10.1016\/S0140-6736(05)67660-X"},{"key":"10.1160\/TH12-06-0377-6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.09.067"},{"key":"10.1160\/TH12-06-0377-7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"10.1160\/TH12-06-0377-8","doi-asserted-by":"crossref","unstructured":"Wiviott SD, Braunwald E, McCabe CH, et al.; TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007; 357: 2001-2015","DOI":"10.1056\/NEJMoa0706482"},{"key":"10.1160\/TH12-06-0377-9","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.656173"},{"key":"10.1160\/TH12-06-0377-10","doi-asserted-by":"publisher","DOI":"10.2165\/00129784-200707040-00006"},{"key":"10.1160\/TH12-06-0377-11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)09457-3"},{"key":"10.1160\/TH12-06-0377-12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16721-4"},{"key":"10.1160\/TH12-06-0377-13","doi-asserted-by":"crossref","unstructured":"Bhatt DL, Fox KA, Hacke W, et al.; CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354: 1706-1717","DOI":"10.1056\/NEJMoa060989"},{"key":"10.1160\/TH12-06-0377-14","doi-asserted-by":"crossref","unstructured":"Berger JS, Roe MT, Gibson CM, et al. Safety and feasibility of adjunctive antiplatelet therapy with intravenous elinogrel, a direct- acting and reversible P2Y12 ADP-receptor antagonist, before primary percutaneous intervention in patients with ST-elevation myocardial infarction: the Early Rapid ReversAl of platelet thromboSis with intravenous Elinogrel before PCI to optimize reperfusion in acute Myocardial Infarction (ERASE MI) pilot trial. Am Heart J 2009; 158: 998 -1004.e1","DOI":"10.1016\/j.ahj.2009.10.010"},{"key":"10.1160\/TH12-06-0377-15","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"10.1160\/TH12-06-0377-16","doi-asserted-by":"crossref","unstructured":"Wiviott SD, Antman EM, Winters KJ, et al.; JUMBO-TIMI 26 Investigators. Randomized comparison of prasugrel (CS-747, LY640315), a novel thienopyridine P2Y12 antagonist, with clopidogrel in percutaneous coronary intervention: results of the Joint Utilization of Medications to Block Platelets Optimally (JUMBO)-TIMI 26 trial. Circulation 2005; 111: 3366-3373","DOI":"10.1161\/CIRCULATIONAHA.104.502815"},{"key":"10.1160\/TH12-06-0377-17","doi-asserted-by":"crossref","unstructured":"Cannon CP, Husted S, Harrington RA, et al.; DISPERSE-2 Investigators. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. J Am Coll Cardiol 2007; 50: 1844-1851","DOI":"10.1016\/j.jacc.2007.07.053"},{"key":"10.1160\/TH12-06-0377-18","doi-asserted-by":"crossref","unstructured":"Roe MT, Armstrong PW, Fox KA, et al.; the TRILOGY ACS Investigators. Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization. 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