High on-treatment platelet reactivity with ticagrelor versus prasugrel: a systematic review and meta-analysis

BackgroundTicagrelor and prasugrel have shown superiority over clopidogrel. However, it remains unclear if one is superior to another regarding on-treatment platelet reactivity. ObjectivesTo compare the impact of ticagrelor and prasugrel on high on-treatment platelet reactivity (HTPR). MethodsThe PubMed and Cochrane databases were searched for eligible studies in December 2014. Studies were eligible if they compared ticagrelor and prasugrel regarding high on-treatment platelet reactivity (HTPR). Pooled estimates were calculated by using a random-effects model with 95% confidence intervals. ResultsWe included 14 studies and 1822 patients: 805 and 1017 in the ticagrelor and prasugrel groups, respectively. The rate of HTPR was significantly lower in the ticagrelor group: 1.5% vs. 9.8% (RR=0.27 [0.14-0.50]). The pre-specified analysis focusing on randomized trials (n=10) showed consistent results (RR=0.27 [0.12-0.60]). ConclusionOur results suggest that ticagrelor allows a higher platelet reactivity inhibition as compared with prasugrel and leads to a further decrease in the rate of HTPR.