Summary

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• This summary is based on the review of 118 systematic review(s)/meta-analysis(es). ^[1-118]
• Ticagrelor-containing dual antiplatelet therapy (DAPT) significantly reduced the risk of major adverse cardiovascular events (MACE) compared to clopidogrel in cytochrome 2C19 (CYP2C19) loss-of-function allele carriers (hazard ratio (HR) 0.70); prasugrel also demonstrated a reduced MACE risk compared to clopidogrel (HR 0.81).
• In all-cause mortality, ticagrelor showed a significant reduction compared to clopidogrel (HR 0.82), whereas prasugrel did not demonstrate a statistically significant reduction; ticagrelor monotherapy following short-term DAPT further showed mortality risk reduction (HR 0.80).
• Prasugrel reduced myocardial infarction (MI) risk compared to clopidogrel (HR 0.75), while ticagrelor did not show a significant MI risk reduction relative to clopidogrel.
• Neither ticagrelor nor prasugrel demonstrated significant differences in stroke outcomes compared to clopidogrel, but both agents reduced the risk of stent thrombosis compared to clopidogrel.
• Ticagrelor and prasugrel both increase the risk of major bleeding compared to clopidogrel; however, ticagrelor monotherapy after short-term DAPT significantly reduces major bleeding relative to standard DAPT.
• Both ticagrelor and prasugrel demonstrate a higher risk of minor bleeding compared to clopidogrel, while ticagrelor monotherapy after short-term DAPT shows a reduction in minor bleeding risk compared to standard DAPT.
• Ticagrelor is associated with an increased risk of intracranial hemorrhage compared to clopidogrel.
• Elderly patients (≥75 years) experience an increased bleeding risk with ticagrelor compared to clopidogrel, while patients with CYP2C19 LoF alleles treated with ticagrelor or prasugrel have a similar bleeding risk to those on clopidogrel.
• Patients with CYP2C19 LoF alleles experience a reduced risk of MACE when treated with ticagrelor or prasugrel compared to clopidogrel, with similar safety profiles in terms of bleeding risk.
• Women on ticagrelor monotherapy may experience a mortality benefit compared to standard DAPT.