Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis
Crushed or chewed potent P2Y12 inhibitors are commonly used in the hope of bridging the gap of platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The study aimed to investigate the efficacy and safety...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-07-01
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| Series: | Platelets |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/09537104.2021.1974370 |
| _version_ | 1797684158414192640 |
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| author | Chen Guo Jin-Rui Zhao Meng-Jie Chen Yue Zhang Rui-Yun Wu Qiang-Qiang Li Hong Zhao Jin Wei |
| author_facet | Chen Guo Jin-Rui Zhao Meng-Jie Chen Yue Zhang Rui-Yun Wu Qiang-Qiang Li Hong Zhao Jin Wei |
| author_sort | Chen Guo |
| collection | DOAJ |
| description | Crushed or chewed potent P2Y12 inhibitors are commonly used in the hope of bridging the gap of platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The study aimed to investigate the efficacy and safety of this alternative oral administration strategy by performing a meta-analysis of available randomized clinical trials (RCTs). PubMed, Embase, the Cochrane Library and Web of Science medical literature databases were searched for RCTs comparing crushed/chewed vs. integral administration of loading dose potent P2Y12 inhibitors in patients with STEMI undergoing pPCI with no language restrictions from inception to January 20th, 2021. The primary efficacy endpoints of high on treatment platelet reactivity (HPR) and P2Y12 reaction units (PRU) at 1 hour together with safety and additional clinical endpoints were evaluated by pooled odds ratio (OR) or mean differences (MD) with 95% confidence intervals (95% CI). A total of 973 patents in six RCTs were eligible for analysis, while 876 patients present baseline and procedural characteristics. HPR and PRU at 1 hour were significantly reduced in the group receiving crushed/chewed P2Y12 inhibitors compared with integral tablets (OR 0.28, 95% CI 0.16 to 0.49, P < .0001; MD −60.62, 95% CI −97.06 to −24.19, P = .001, respectively). Safety endpoints of major bleeding (OR 0.54, 95% CI 0.11 to 2.73, P = .46) and any bleeding (OR 0.84, 95% CI 0.43 to 1.64, P = .61), as well as additional clinical endpoints of cardiovascular death, myocardial infarction, and stroke were not affected by the oral administration strategy. In STEMI patients undergoing pPCI, crushed or chewed administration of potent P2Y12 inhibitors are associated with enhanced early platelet inhibition and appear to be safe. The clinical profile transformed from this pharmacodynamic benefit need to be determined by further researches. |
| first_indexed | 2024-03-12T00:25:26Z |
| format | Article |
| id | doaj.art-ab9844f4ed1143a99b835d3b0aed6739 |
| institution | Directory Open Access Journal |
| issn | 0953-7104 1369-1635 |
| language | English |
| last_indexed | 2024-03-12T00:25:26Z |
| publishDate | 2022-07-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Platelets |
| spelling | doaj.art-ab9844f4ed1143a99b835d3b0aed67392023-09-15T10:38:10ZengTaylor & Francis GroupPlatelets0953-71041369-16352022-07-0133567968610.1080/09537104.2021.19743701974370Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysisChen Guo0Jin-Rui Zhao1Meng-Jie Chen2Yue Zhang3Rui-Yun Wu4Qiang-Qiang Li5Hong Zhao6Jin Wei7The Second Affiliated Hospital of Xi’an Jiaotong UniversityThe Second Affiliated Hospital of Xi’an Jiaotong UniversityThe Second Affiliated Hospital of Xi’an Jiaotong UniversityThe Second Affiliated Hospital of Xi’an Jiaotong UniversityThe Second Affiliated Hospital of Xi’an Jiaotong UniversityThe Second Affiliated Hospital of Xi’an Jiaotong UniversityThe Second Affiliated Hospital of Xi’an Jiaotong UniversityThe Second Affiliated Hospital of Xi’an Jiaotong UniversityCrushed or chewed potent P2Y12 inhibitors are commonly used in the hope of bridging the gap of platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The study aimed to investigate the efficacy and safety of this alternative oral administration strategy by performing a meta-analysis of available randomized clinical trials (RCTs). PubMed, Embase, the Cochrane Library and Web of Science medical literature databases were searched for RCTs comparing crushed/chewed vs. integral administration of loading dose potent P2Y12 inhibitors in patients with STEMI undergoing pPCI with no language restrictions from inception to January 20th, 2021. The primary efficacy endpoints of high on treatment platelet reactivity (HPR) and P2Y12 reaction units (PRU) at 1 hour together with safety and additional clinical endpoints were evaluated by pooled odds ratio (OR) or mean differences (MD) with 95% confidence intervals (95% CI). A total of 973 patents in six RCTs were eligible for analysis, while 876 patients present baseline and procedural characteristics. HPR and PRU at 1 hour were significantly reduced in the group receiving crushed/chewed P2Y12 inhibitors compared with integral tablets (OR 0.28, 95% CI 0.16 to 0.49, P < .0001; MD −60.62, 95% CI −97.06 to −24.19, P = .001, respectively). Safety endpoints of major bleeding (OR 0.54, 95% CI 0.11 to 2.73, P = .46) and any bleeding (OR 0.84, 95% CI 0.43 to 1.64, P = .61), as well as additional clinical endpoints of cardiovascular death, myocardial infarction, and stroke were not affected by the oral administration strategy. In STEMI patients undergoing pPCI, crushed or chewed administration of potent P2Y12 inhibitors are associated with enhanced early platelet inhibition and appear to be safe. The clinical profile transformed from this pharmacodynamic benefit need to be determined by further researches.http://dx.doi.org/10.1080/09537104.2021.1974370chewedcrushedp2y12 inhibitorpercutaneous coronary interventionst-segment elevation myocardial infarction |
| spellingShingle | Chen Guo Jin-Rui Zhao Meng-Jie Chen Yue Zhang Rui-Yun Wu Qiang-Qiang Li Hong Zhao Jin Wei Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis Platelets chewed crushed p2y12 inhibitor percutaneous coronary intervention st-segment elevation myocardial infarction |
| title | Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis |
| title_full | Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis |
| title_fullStr | Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis |
| title_full_unstemmed | Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis |
| title_short | Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis |
| title_sort | crushed chewed administration of potent p2y12 inhibitors in st segment elevation myocardial infarction undergoing primary percutaneous coronary intervention systematic review and meta analysis |
| topic | chewed crushed p2y12 inhibitor percutaneous coronary intervention st-segment elevation myocardial infarction |
| url | http://dx.doi.org/10.1080/09537104.2021.1974370 |
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