acute coronary syndrome - antiplatelets drug - ACS (excluding AMI) clinical trials results meta-analysis

<h1> <a href="TM16-2-antiplatelets drug-acute coronary syndrome" > <strong>acute coronary syndrome</strong> - antiplatelets drug </a> - ACS (excluding AMI) trial results systematic overview and meta-analysis </h1> <h2>Main characteristics of the included studies</h2> <table> <tr> <th>Trial</th> <th>Treatments</th> <th>Patients</th> <th>Methods</th> </tr> <tr> <td> <a href="../TRC_t4023.htm"> VA-pilot, 0 </a> <br> </td> <td> Aspirin 324 mg/d<br>  <i>versus</i> <br> </td> <td> </td> <td> follow-up 3m<br> n=26/24<br> <br> <br> </td> </tr> <tr> <td> <a href="../TRC_t4024.htm"> VA-main, 1983 </a> <br> </td> <td> Aspirin 324mg/d<br>  <i>versus</i> <br> placebo </td> <td> men with unstable angina </td> <td> follow-up 3m<br> n=661/677<br> <br> double blind <br> </td> </tr> <tr> <td> <a href="../TRC_t4025.htm"> Canadian (Aspirin + sulfinpyrazone), 1985 </a> <br> </td> <td> Aspirin 1300mg/d + sulfinpyrazone 800mg/d<br>  <i>versus</i> <br> placebo </td> <td> patients with unstable angina </td> <td> follow-up 18m<br> n=416/139<br> <br> double blind <br> </td> </tr> <tr> <td> <a href="../TRC_t4026.htm"> RISC, 1990 </a> <br> </td> <td> Aspirin 75mg/d<br>  <i>versus</i> <br> placebo </td> <td> men with unstable coronary artery disease (unstable angina or non-Q wave myocardial infarction </td> <td> follow-up 12m<br> n=474/471<br> Factorial plan<br> double blind <br> Sweden </td> </tr> <tr> <td> <a href="../TRC_t4027.htm"> ALDUSA-pilot, 0 </a> <br> </td> <td> Aspirin 325mg/d, Aspirin 40mg/d<br>  <i>versus</i> <br> </td> <td> </td> <td> follow-up 12m<br> n=56/28<br> <br> <br> </td> </tr> <tr> <td> <a href="../TRC_t4028.htm"> STAI, 1990 </a> <br> </td> <td> ticlopidine 250 mg b.i.d<br>  <i>versus</i> <br> untreated control </td> <td> patients with unstable angina <=48hrs from the pain onset </td> <td> follow-up 6m<br> n=314/338<br> <br> single blind <br> </td> </tr> <tr> <td> <a href="../TRC_t4029.htm"> Prandoni, 1991 </a> <br> </td> <td> Aspirin 50mg/d + Dipyridamol 400mg/d<br>  <i>versus</i> <br> placebo </td> <td> patients with acute unstable angina </td> <td> follow-up 12m<br> n=44/44<br> <br> double blind <br> </td> </tr> <tr> <td> <a href="../TRC_t4030.htm"> Théroux, 1988 </a> <br> </td> <td> Aspirin 325 mg twice daily<br>  <i>versus</i> <br> placebo </td> <td> acute unstable angina </td> <td> follow-up 6d (3m)<br> n=121/118<br> <br> double blind <br> </td> </tr> <tr> <td> <a href="../TRC_t4031.htm"> Florida UA, 0 </a> <br> </td> <td> Ticlopidine 500mg/d<br>  <i>versus</i> <br> </td> <td> </td> <td> follow-up 14d<br> n=12/12<br> <br> <br> </td> </tr> <tr> <td> <a href="../TRC_t4032.htm"> ATACS-pilot, 1990 </a> <br> </td> <td> Aspirin 80mg/d (Heparin + Warfarin)<br>  <i>versus</i> <br> full-dose heparin followed by warfarin </td> <td> acute coronary syndromes </td> <td> follow-up 3m<br> n=37/24<br> <br> <br> </td> </tr> <tr> <td> <a href="../TRC_t4033.htm"> Plaza, 1993 </a> <br> </td> <td> triflusal 300 mg three times daily<br>  <i>versus</i> <br> placebo </td> <td> patients with unstable angina </td> <td> follow-up 6m<br> n=143/138<br> Parallel groups<br> double blind <br> Spain </td> </tr> <tr> <td> <a href="../TRC_t4034.htm"> Modena, 0 </a> <br> </td> <td> trapidil<br>  <i>versus</i> <br> </td> <td> </td> <td> follow-up 6m<br> n=71/73<br> <br> <br> </td> </tr> <tr> <td> <a href="../TRC_t8296.htm"> CURE, 2001 </a> <br> </td> <td> clopidogrel 300 mg immediately, followed by 75 mg once daily + aspirin for 3 to 12 months<br>  <i>versus</i> <br> aspirin (+placebo) </td> <td> acute coronary syndromes without ST-segment elevation within 24 hours after the onset of symptoms </td> <td> follow-up NA (median <9 months)<br> n=6259/6303<br> Parallel groups<br> double blind <br> 28 countries </td> </tr> <tr> <td> <a href="../TRC_t8565.htm"> Canadian (Aspirin vs PBO), 1985 </a> <br> </td> <td> Aspirin 1300mg/d <br>  <i>versus</i> <br> placebo </td> <td> patients with unstable angina </td> <td> follow-up 18m<br> n=-9/139<br> <br> double blind <br> </td> </tr> <tr> <td> <a href="../TRC_t8566.htm"> Canadian (sulfinpyrazone alone), 1985 </a> <br> </td> <td> sulfinpyrazone 800mg/d <br>  <i>versus</i> <br> placebo </td> <td> patients with unstable angina </td> <td> follow-up 18m<br> n=-9/139<br> <br> double blind <br> </td> </tr> <tr> <td> <a href="../TRC_t9696.htm"> PLATO, 2009 </a> <br> NCT00391872 </td> <td> ticagrelor 90mg twice daily<br>  <i>versus</i> <br> clopidogrel 75mg once daily </td> <td> patients with an acute coronary syndrome, with or without ST-segment elevation (onset of symptoms within the previous 24h). </td> <td> follow-up 1 y<br> n=9333/9291<br> Parallel groups<br> double blind <br> 43 countries </td> </tr> <tr> <td> <a href="../TRC_t9697.htm"> DISPERSE-2 (90mg), 2007 </a> <br> </td> <td> ticagrelor 90 mg twice daily<br>  <i>versus</i> <br> clopidogrel </td> <td> patients with NSTE-ACS, treated with aspirin and standard therapy for ACS </td> <td> follow-up 12 weeks<br> n=334/327<br> Parallel groups<br> double blind <br> </td> </tr> <tr> <td> <a href="../TRC_t8295.htm"> TRILOGY, 0 </a> <br> NCT00699998 </td> <td> prasugrel<br>  <i>versus</i> <br> clopidogrel </td> <td> patients who are to be medically managed without a planned PCI. </td> <td> follow-up <br> n=-9/-9<br> <br> <br> </td> </tr> <tr> <td> <a href="../TRC_t9883.htm"> CURRENT OASIS 7 (clopidogrel), </a> <br> NCT00335452 </td> <td> <br>  <i>versus</i> <br> </td> <td> </td> <td> follow-up <br> n=-9/-9<br> <br> <br> </td> </tr> <tr> <td> <a href="../TRC_t9884.htm"> CURRENT - OASIS 7 (ASA), </a> <br> NCT00335452 </td> <td> <br>  <i>versus</i> <br> </td> <td> </td> <td> follow-up <br> n=-9/-9<br> <br> <br> </td> </tr> </table> <h2>References</h2> <p> <b>VA-pilot, 0 : </b> Lewis HD <i>Circulation 1985;72 (suppl V):155-60</i> [PMID ] </p> <p> <b>VA-main, 1983 : </b> Lewis HD Jr, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE 3rd, Schnaper HW, LeWinter MM, Linares E, Pouget JM, Sabharwal SC, Chesler E, DeMots HProtective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. <i>N Engl J Med 1983;309:396-403</i> [PMID 6135989] </p> <p> <b>Canadian (Aspirin + sulfinpyrazone), 1985 : </b> Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA, Jablonsky G, Kostuk WJ, Melendez LJ, Myers MGAspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. <i>N Engl J Med 1985;313:1369-75</i> [PMID 3903504] </p> <p> <b>RISC, 1990 : </b> Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. The RISC Group. <i>Lancet 1990;336:827-30</i> [PMID 1976875] </p> <p> <b>RISC, 1990 : </b> Wallentin LCAspirin (75 mg/day) after an episode of unstable coronary artery disease: long-term effects on the risk for myocardial infarction, occurrence of severe angina and the need for revascularization. Research Group on Instability in Coronary Artery Disease in Southeast Sweden. <i>J Am Coll Cardiol 1991;18:1587-93</i> [PMID 1960301] </p> <p> <b>ALDUSA-pilot, 0 : </b> <i>Unité de Pharmacologie Clinique, 1987. (Unité de Pharmacologie Clinique unpublished report)</i> [PMID ] </p> <p> <b>STAI, 1990 : </b> Balsano F, Rizzon P, Violi F, Scrutinio D, Cimminiello C, Aguglia F, Pasotti C, Rudelli GAntiplatelet treatment with ticlopidine in unstable angina. A controlled multicenter clinical trial. The Studio della Ticlopidina nell'Angina Instabile Group. <i>Circulation 1990;82:17-26</i> [PMID 2194694] </p> <p> <b>STAI, 1990 : </b> Scrutinio D, Lagioia R, Rizzon PTiclopidine treatment for patients with unstable angina at rest. A further analysis of the study of ticlopidine in unstable angina. Studio della Ticlopidina nell'Angina Instabile Group. <i>Eur Heart J 1991;12 Suppl G:27-9</i> [PMID 1806376] </p> <p> <b>Prandoni, 1991 : </b> Prandoni P, Milani L, Barbiero M, Cardaioli P, Sanson A, Barbaresi F, Zonzin P, Visani L[Treatment of unstable angina with dipyridamole combined with low doses of aspirin. A multicenter pilot double-blind controlled study] <i>Minerva Cardioangiol 1991;39:267-73</i> [PMID 1780077] </p> <p> <b>Théroux, 1988 : </b> Theroux P, Ouimet H, McCans J, Latour JG, Joly P, Levy G, Pelletier E, Juneau M, Stasiak J, deGuise PAspirin, heparin, or both to treat acute unstable angina. <i>N Engl J Med 1988 Oct 27;319:1105-11</i> [PMID 3050522] </p> <p> <b>Florida UA, 0 : </b> Mehta JL <i>Unité de Pharmacologie Clinique, 1987. (Unité de Pharmacologie Clinique unpublished report)</i> [PMID ] </p> <p> <b>ATACS-pilot, 1990 : </b> Cohen M, Adams PC, Hawkins L, Bach M, Fuster VUsefulness of antithrombotic therapy in resting angina pectoris or non-Q-wave myocardial infarction in preventing death and myocardial infarction (a pilot study from the Antithrombotic Therapy in Acute Coronary Syndromes Study Group). <i>Am J Cardiol 1990 Dec 1;66:1287-92</i> [PMID 2244556] </p> <p> <b>Plaza, 1993 : </b> Plaza L, Lopez-Bescos L, Martin-Jadraque L, Alegria E, Cruz-Fernandez JM, Velasco J, Ruiperez JA, Malpartida F, Artal A, Cabades AProtective effect of triflusal against acute myocardial infarction in patients with unstable angina: results of a Spanish multicenter trial. Grupo de Estudio del Triflusal en la Angina Inestable. <i>Cardiology 1993;82:388-98</i> [PMID 8402761] </p> <p> <b>Modena, 0 : </b> Reggiani S, Mattioli Gí <i>J Am Coll Cardiol 1992;19:238A (Abstract 942-65)</i> [PMID ] </p> <p> <b>CURE, 2001 : </b> Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KKEffects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. <i>N Engl J Med 2001;345:494-502</i> [PMID 11519503] </p> <p> <b>Canadian (Aspirin vs PBO), 1985 : </b> Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA, Jablonsky G, Kostuk WJ, Melendez LJ, Myers MG <i>N Engl J Med 1985;313:1369-75</i> [PMID 3903504] </p> <p> <b>Canadian (sulfinpyrazone alone), 1985 : </b> Cairns JA, Gent M, Singer J, Finnie KJ, Froggatt GM, Holder DA, Jablonsky G, Kostuk WJ, Melendez LJ, Myers MG <i>N Engl J Med 1985;313:1369-75</i> [PMID 3903504] </p> <p> <b>TRITON-TIMI 38, 2007 : </b> Antman EM, Wiviott SD, Murphy SA, Voitk J, Hasin Y, Widimsky P, Chandna H, Macias W, McCabe CH, Braunwald EEarly and late benefits of prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a TRITON-TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel-Thrombolysis In Myocardial Infarction) analysis. <i>J Am Coll Cardiol 2008 May 27;51:2028-33</i> [PMID 18498956] </p> <p> <b>TRITON-TIMI 38, 2007 : </b> Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EMPrasugrel versus clopidogrel in patients with acute coronary syndromes. <i>N Engl J Med 2007;357:2001-15</i> [PMID 17982182] </p> <p> <b>Huynh (warfarin vs aspirin), 2001 : </b> Huynh T, Théroux P, Bogaty P, Nasmith J, Solymoss SAspirin, warfarin, or the combination for secondary prevention of coronary events in patients with acute coronary syndromes and prior coronary artery bypass surgery. <i>Circulation 2001;103:3069-74</i> [PMID 11425770] </p> <p> <b>PLATO, 2009 : </b> James S, Akerblom A, Cannon CP, Emanuelsson H, Husted S, Katus H, Skene A, Steg PG, Storey RF, Harrington R, Becker R, Wallentin LComparison of ticagrelor, the first reversible oral P2Y(12) receptor antagonist, with clopidogrel in patients with acute coronary syndromes: Rationale, design, and baseline characteristics of the PLATelet inhibition and patient Outcomes (PLATO) trial. <i>Am Heart J 2009;157:599-605</i> [PMID 19332184] </p> <p> <b>PLATO, 2009 : </b> Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RATicagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. <i>N Engl J Med 2009 Aug 30;:</i> [PMID 19717846] 10.1056/NEJMoa0904327 </p> <p> <b>DISPERSE-2 (90mg), 2007 : </b> Cannon CP, Husted S, Harrington RA, Scirica BM, Emanuelsson H, Peters G, Storey RFSafety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. <i>J Am Coll Cardiol 2007;50:1844-51</i> [PMID 17980250] </p> <p> <b>DISPERSE-2 (90mg), 2007 : </b> Storey RF, Husted S, Harrington RA, Heptinstall S, Wilcox RG, Peters G, Wickens M, Emanuelsson H, Gurbel P, Grande P, Cannon CPInhibition of platelet aggregation by AZD6140, a reversible oral P2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndromes. <i>J Am Coll Cardiol 2007;50:1852-6</i> [PMID 17980251] </p> <p> <b>CURRENT OASIS 7 (clopidogrel), : </b> Mehta SR, Bassand JP, Chrolavicius S, Diaz R, Fox KA, Granger CB, Jolly S, Rupprecht HJ, Widimsky P, Yusuf SDesign and rationale of CURRENT-OASIS 7: a randomized, 2 x 2 factorial trial evaluating optimal dosing strategies for clopidogrel and aspirin in patients with ST and non-ST-elevation acute coronary syndromes managed with an early invasive strategy. <i>Am Heart J 2008 Dec;156:1080-1088.e1</i> [PMID 19033002] </p> <p> <b>CURRENT - OASIS 7 (ASA), : </b> Mehta SR, Bassand JP, Chrolavicius S, Diaz R, Fox KA, Granger CB, Jolly S, Rupprecht HJ, Widimsky P, Yusuf SDesign and rationale of CURRENT-OASIS 7: a randomized, 2 x 2 factorial trial evaluating optimal dosing strategies for clopidogrel and aspirin in patients with ST and non-ST-elevation acute coronary syndromes managed with an early invasive strategy. <i>Am Heart J 2008 Dec;156:1080-1088.e1</i> [PMID 19033002] </p>