Abstract 4146894: Switching to Ticagrelor from clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: A meta-analysis of 4334 patients

Introduction: For patients undergoing fibrinolytic therapy for ST-elevation myocardial infarction (STEMI), The concurrent administration of aspirin and clopidogrel as dual antiplatelet therapy is the recommended standard of care for these patients. However, the efficacy and safety of switching to ticagrelor within 24 hours following fibrinolytic treatment compared to clopidogrel continuation is still a debate. Purpose: We aimed to compare ticagrelor and clopidogrel regarding the efficacy and safety outcomes in patients with STEMI receiving fibrinolytic therapy. Methods: We performed an extensive electronic search on PubMed, Scopus, Web of Science, and Cochrane Library from inception till February 2024. All randomized controlled trials (RCTs) that compared between ticagrelor and clopidogrel in the setting of STEMI were included. The primary endpoint was all-cause death. The secondary outcomes were myocardial infarction and Bleeding Academic Research Consortium classification (BARC) 1-2. Results: Four randomized controlled trials involving 4334 patients were included in the analysis. Ticagrelor showed higher rates of BARC 1-2 bleeding events compared to clopidogrel (OR= 1.68, 95% CI [ 1.22 to 2.31], P=0.002), with no significant difference regarding the incidence of all-cause death (OR= 0.89, 95% CI [ 0.61 to 1.31], P=0.56) or MI (OR= 0.76, 95% CI [ 0.42 to 1.35], P=0.35). Conclusion: Ticagrelor was associated with a higher incidence of bleeding events compared to clopidogrel, with no significant difference in other clinical outcomes. Switching to ticagrelor from clopidogrel might worsen the case regarding clinical outcomes. Large-volume RCTs should be implanted with longer follow-up to validate the current findings.