Efficacy and Safety of Prasugrel, Ticagrelor, or Clopidogrel After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

Background

To assess the efficacy and safety of oral P2Y12 inhibitors in patients who underwent PCI.

评估口服P2Y12抑制剂在进行PCI的患者中的疗效和安全性。

data_sources_and_study_selection

PubMed and Embase were searched until November 15, 2025, for randomized clinical trials comparing at least 2 of the 3 agents.

截至2025年11月15日，通过PubMed和Embase检索了比较至少2种中的3种药物的随机临床试验。

data_extraction_and_synthesis

Data were abstracted by 2 independent authors according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.

数据由2位独立作者根据系统评价和荟萃分析的首选报告项目（PRISMA）报告指南进行摘录。

Random-effects odds ratios (ORs) and 95% confidence intervals were calculated.

计算了随机效应的优势比(ORs)和95%置信区间。

Data were analyzed in December 2025.

数据于2025年12月进行了分析。

main_outcomes_and_measures

The primary efficacy outcome was major adverse cardiovascular events (MACE), while the primary safety outcome was major bleeding.

主要疗效结果是主要不良心血管事件（MACE），而主要安全性结果是主要出血事件。

The primary analysis compared prasugrel and ticagrelor in reference to clopidogrel using a mixed treatment comparison meta-analysis.

主要分析比较了普拉格雷和替格瑞洛相对于氯吡格雷的疗效，使用了混合治疗比较的荟萃分析方法。

Results

Data were analyzed from 15 randomized clinical trials that included 48 904 patients (mean [SD] age, 63.2 [4.21] years; 13 330 female patients [27.3%]).

分析了来自15项随机临床试验的数据，这些试验共纳入了48,904名患者（平均[标准差]年龄为63.2[4.21]岁；13,330名女性患者[27.3%]）。

Compared with clopidogrel, there was a lower risk of MACE (OR, 0.80; 95% CI, 0.69-0.93) driven by lower myocardial infarction (OR, 0.71; 95% CI, 0.62-0.82) and stent thrombosis (OR, 0.48; 95% CI, 0.37-0.62) with prasugrel.

与氯吡格雷相比，使用普拉格雷的患者主要心血管不良事件（MACE）风险较低（OR, 0.80; 95% 置信区间, 0.69-0.93），这主要由心肌梗死（OR, 0.71; 95% 置信区间, 0.62-0.82）和支架血栓形成（OR, 0.48; 95% 置信区间, 0.37-0.62）的降低所驱动。

MACE was not reduced with ticagrelor compared with clopidogrel, although there was lower stent thrombosis (OR, 0.73; 95% CI, 0.59-0.91).

与氯吡格雷相比，替卡格雷并未降低主要不良心血管事件（MACE），尽管支架血栓的发生率较低（OR，0.73；95% 置信区间，0.59-0.91）。

Furthermore, there was lower risk of MACE with prasugrel compared to ticagrelor (OR, 0.83; 95% CI, 0.70-0.98) driven by lower myocardial infarction (OR, 0.78; 95% CI, 0.65-0.94) and stent thrombosis (OR, 0.66; 95% CI, 0.49-0.88).

此外，与替卡格雷相比，普拉格雷降低主要不良心血管事件（MACE）风险（OR，0.83；95% 置信区间，0.70-0.98），这主要由较低的心肌梗死（OR，0.78；95% 置信区间，0.65-0.94）和支架血栓（OR，0.66；95% 置信区间，0.49-0.88）驱动。

There was a higher risk of major bleeding with ticagrelor vs clopidogrel (OR, 1.24; 95% CI, 1.01-1.52) driven by higher intracranial hemorrhage (OR, 1.89; 95% CI, 1.08-3.33).

与氯吡格雷相比，替卡格雷有更高的主要出血风险（OR，1.24；95% CI，1.01-1.52），这主要由更高的颅内出血风险驱动（OR，1.89；95% CI，1.08-3.33）。

Prasugrel ranked first, followed by ticagrelor and clopidogrel, for MACE, myocardial infarction, and stent thrombosis.

在主要不良心血管事件、心肌梗死和支架血栓形成方面，普拉格雷排名第一，其次是替卡格雷和氯吡格雷。

conclusions_and_relevance

In this systematic reviewand meta-analysisof 15 randomized clinical trials in patients who underwent PCI, prasugrel provided the optimal balance between efficacy and safety compared with ticagrelor and clopidogrel.

在这项涉及15项随机临床试验的系统评价和荟萃分析中，接受经皮冠状动脉介入治疗（PCI）的患者使用普拉格雷在疗效和安全性之间提供了与替卡格雷和氯吡格雷相比的最佳平衡。