Background

Clopidogrel is routinely used to decrease ischemic complications during neurointerventional procedures. However, the efficacy may be limited by the antiplatelet resistance.

Purpose

To analyze the efficacy of prasugrel (PS) compared to clopidogrel (CP) in the cerebrovascular field.

Data sources

A systematic search of two large databases was performed for studies published from 2000 to 2018.

Study selection

According to PRISMA guidelines, we included studies reporting treatment-related outcomes of patients undergoing neurointerventional procedures under PS, and studies comparing PS and CP.

Data analysis

Random-effects meta-analysis was used to pool the following: overall rate of complications, ischemic and hemorrhagic events, influence of the dose of PS.

Data synthesis

Including 7 studies, 682 and 672 unruptured intracranial aneurysms were treated under PS (cases) and CP (controls), respectively. Low-dose (20 mg/5 mg) (loading and maintenance doses) of PS compared with the standard dose of CP (300 mg/75 mg) showed a significant reduction of the complication rate (OR = 0.36, 95% CI = 0.17–74, P = 0.006, I² = 0%). Overall, ischemic complication rate was significantly higher among the CP group (40/672 = 6%, 95% CI = 3%–13%, I² = 83% vs 16/682 = 2%, 95% CI = 1%–5%, I² = 73%, P = 0.03). Low and high loading doses of PS were associated with 0.6% (5/535, 95% CI = 0.1%–1.6%, I² = 0%) and 9.3% (13/147, 95% CI = 0.2%–18%, I² = 60%) of intra-periprocedural hemorrhages, respectively (P = 0.001), whereas low and high maintenance doses of PS were associated with 0% (0/433) and 0.9% (2/249, 95% CI = 0.3%–2%, I² = 0%) of delayed hemorrhagic events, respectively (P = 0.001).

Limitations

Retrospective series and heterogeneous endovascular treatments.

Conclusions

In our study, low-dose of prasugrel, compared with clopidogrel premedication, is associated with an effective reduction of the ischemic events with an acceptable rate of hemorrhagic complications.

中文翻译：

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普拉格雷和氯吡格雷作为抗血小板药物用于颅内动脉瘤破裂的血管内治疗的比较。荟萃分析

背景

氯吡格雷通常用于减少神经介入手术期间的缺血性并发症。然而，功效可能受到抗血小板抵抗性的限制。

目的

为了分析普拉格雷（PS）与氯吡格雷（CP）在脑血管领域的疗效。

数据源

对2000年至2018年发表的研究进行了两个大型数据库的系统搜索。

研究选择

根据PRISMA指南，我们纳入了报告在PS下接受神经介入治疗的患者的治疗相关结局的研究，以及比较PS和CP的研究。

数据分析

随机效应荟萃分析用于汇总以下内容：并发症的总体发生率，缺血和出血事件，PS剂量的影响。

数据综合

包括7项研究在内，分别在PS（病例）和CP（对照）下治疗了682和672例未破裂的颅内动脉瘤。与标准剂量的CP（300 mg / 75 mg）相比，PS的低剂量（20 mg / 5 mg）（负荷和维持剂量）显示并发症发生率显着降低（OR = 0.36，95％CI = 0.17） –74，P  = 0.006，I ²  = 0％）。总体而言，CP组的缺血并发症发生率明显更高（40/672 = 6％，95％CI = 3％–13％，I ²  = 83％，而16/682 = 2％，95％CI = 1％– 5％，I ²  = 73％，P  = 0.03）。PS的低负荷和高负荷剂量分别有0.6％（5/535，95％CI = 0.1％–1.6％，I ²  = 0％）和9.3％（13/147，95％CI = 0.2％–18％） ，我² = 60％）的围手术期内出血（P  = 0.001），而维持低剂量和高剂量PS分别与0％（0/433）和0.9％（2/249，95％CI = 0.3％– 2％，I ²  = 0％）的延迟出血事件（P  = 0.001）。

局限性

回顾性系列和异种血管内治疗。

结论

在我们的研究中，与氯吡格雷预用药相比，低剂量的普拉格雷可有效减少缺血事件，并具有可接受的出血并发症发生率。