Ticagrelor Versus Prasugrel for the Treatment of Patients with Type 2 Diabetes Mellitus Following Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

INTRODUCTION: Antiplatelet therapy is very important following percutaneous coronary intervention (PCI). New generation P2Y(12) inhibitors (ticagrelor and prasugrel) might potentially replace clopidogrel for the treatment of post-interventional acute coronary syndrome (ACS). In this analysis, we aimed to systematically compare the post-interventional clinical outcomes and bleeding events observed with ticagrelor versus prasugrel in patients with type 2 diabetes mellitus (T2DM). METHODS: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, and www.ClinicalTrials.gov were carefully searched for publications comparing the post-coronary interventional outcomes following ticagrelor versus prasugrel use in patients with T2DM. Adverse clinical outcomes and bleeding events were considered as the endpoints. Statistical analysis was carried out by the Revman software (version 5.3). Odds ratios (OR) and 95% confidence intervals (CI) were used to represent the data during subgroup analysis. RESULTS: A total of 2004 participants with T2DM were included in this analysis. Following PCI, mortality (OR 1.00, 95% CI 0.57–1.76; P = 0.99, I(2) = 19%), myocardial infarction (OR 0.86, 95% CI 0.42–1.75; P = 0.67, I(2) = 0%), major adverse cardiac events (OR 0.73, 95% CI 0.42–1.27; P = 0.27, I(2) = 0%), and stroke (OR 0.72, 95% CI 0.20–2.59; P = 0.61, I(2) = 0%) were not significantly different between ticagrelor and prasugrel. In addition, total bleeding events (OR 0.87, 95% CI 0.55–1.40; P = 0.58, I(2) = 6%), Thrombolysis in Myocardial Infarction (TIMI) defined minor bleeding (OR 2.39, 95% CI 0.58–9.91; P = 0.23, I(2) = 0%), TIMI defined major bleeding (OR 1.42, 95% CI 0.27–7.45; P = 0.68, I(2) = 0%), bleeding defined according to the Bleeding Academic Research Consortium (BARC) major bleeding (OR 0.55, 95% CI 0.22–1.36; P = 0.20, I(2) = 0%), BARC minor bleeding (OR 1.44, 95% CI 0.52–3.99; P = 0.48, I(2) = 0%), and total minimal bleeding (OR 3.12, 95% CI 0.55–17.59; P = 0.20, I(2) = 0%) were also not significantly different. CONCLUSION: Ticagrelor and prasugrel were not associated with significantly different adverse clinical outcomes and bleeding events in these patients with T2DM. Therefore, both antiplatelet agents might safely be used in patients with T2DM following coronary intervention. However, this head-to-head comparison still remains a major challenge which should be resolved in larger clinical trials.