A Meta-analysis of Haemorrhage with Ticlopidine and Clopidogrel Following Coronary Artery Stent Placement

ABSTRACTBackground: Clopidogrel has largely replaced ticlopidine in antiplatelet therapy after coronary artery stenting because of the higher risk of blood dyscrasias with the latter agent. However, haemorrhage in this setting is not a rare event. We aimed to investigate by meta-analysis the risk of haemorrhage with ticlopidine plus aspirin versus clopidogrel plus aspirin after coronary artery stenting.Methods: A literature search was conducted for studies comparing ticlopidine plus aspirin with clopidogrel plus aspirin in patients undergoing coronary artery stenting procedures. Studies were included in the meta-analysis if they provided data on haemorrhage for both therapies.Results: Seven randomised and 5 non-randomised studies met the entry criteria. After adjustment for a significant imbalance in use of abciximab in one study, the total number of haemorrhages was 82 with ticlopidine (among 4093 patients) and 78 for clopidogrel (among 3714 patients). Meta- analysis found that ticlopidine plus aspirin was associated with a lower risk of haemorrhage than clopidogrel plus aspirin (odds ratio 0.69; 95% confidence interval 0.50-0.97; p=0.03). In the studies providing information on these events, the rate of blood dyscrasias was higher with ticlopidine than with clopidogrel (0.66% vs 0.45%), but this was offset by the lower rate of haemorrhage with ticlopidine (0.71% vs 1.00%).Conclusion: This meta-analysis found that ticlopidine plus aspirin was associated with a significantly lower risk of haemorrhage than clopidogrel plus aspirin after coronary artery stenting. Given the similar efficacy of the two regimens, it may be worth reconsidering the role of ticlopidine as an antiplatelet therapy.