Evidence map›Paper›PMID 40533625›Full record

SynthesisEuropean journal of clinical pharmacology2025

Comparison between clopidogrel and ticagrelor in CYP2C19 loss-of-function alleles coronary artery disease and stroke patients: a meta-analysis.

Mahmoud Elsayed, Mostafa Hossam El Din Moawad, Mohammed Elkholy, Yousr Ahmed, Younes Nabgouri, Gulnaz Bahtiyarova, Ibraheem M Alkhawaldeh, Mohamed Abouzid, Reham M Wagih

Abstract readMeta-AnalysisSystematic ReviewComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European journal of clinical pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mahmoud Elsayed *Stroke and Neurovascular Regulation Laboratory, 149 13 Street, Room 6405, Charlestown, MA, 02129, USA.
Mostafa Hossam El Din Moawad *Alexandria Main University Hospital, Alexandria, Egypt.
Mohammed Elkholy *The Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Yousr AhmedDepartment of Pulmonology and Critical Care, Johns Hopkins University, Baltimore, MD, USA.
Younes NabgouriDepartment of Internal Medicine, First Pavlov State Medical University, Saint Petersburg, Russia.
Gulnaz BahtiyarovaDepartment of Internal Medicine, First Pavlov State Medical University, Saint Petersburg, Russia.
Ibraheem M AlkhawaldehFaculty of Medicine, Mutah University, Al-Karak, Jordan.
Mohamed AbouzidDepartment of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St, 60-806, Poznan, Poland. mmahmoud@ump.edu.pl.
Reham M WagihDepartment of Total Parenteral Nutrition, Alexandria Main University Hospital, Alexandria, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIt is suggested that in patients with coronary artery diseases (CAD) and stroke, the use of ticagrelor and aspirin may perform better than clopidogrel and aspirin regarding the risk of thrombosis/embolism, including recurrent myocardial infarction (MI) and cardiovascular death, especially in those carrying CYP2C19 loss-of-function (LOF) alleles. Therefore, we conducted the present systematic review and meta-analysis to investigate the effect of clopidogrel and ticagrelor in CAD and stroke patients with CYP2C19 LOF alleles (poor metabolizers of clopidogrel).

methodsWe performed the current systematic review and meta-analysis by searching for all eligible publications on PubMed, Web of Science, and Scopus from inception to November 2024. A search strategy employing three primary keywords in conjunction with their corresponding Medical Subject Headings (MeSH) terms: "Ticagrelor" AND "Clopidogrel" AND "CYP2C19" (PROSPERO ID CRD420251050533). We implemented the odds ratio (OR) as an effect estimate for the dichotomous variables. The analysis was done at 95% confidence intervals (CI), and the p-value was significant if it was less than or equal to 0.05.

resultsUsing clopidogrel was associated with an increased risk of thrombosis/embolism compared with ticagrelor, showing OR = 1.78 (95%CI, 1.08, 2.95; p = 0.02). Also, clopidogrel led to an increased risk of stroke, whether when used in stroke or CAD patients with CYP2C19 LOF alleles, compared with ticagrelor, with an overall OR = 1.43 (95%CI, 1.23, 1.66; p < 0.00001) and a higher rate of MI with OR = 1.53 (95%CI, 1.22, 1.92; p = 0.0003). No significant difference was observed between the two groups (clopidogrel and ticagrelor) in stroke or CAD patients with OR = 0.98 (95%CI, 0.79, 1.22; p = 0.87). Also, no significant difference was observed between both groups regarding the risk of minor bleeding in stroke or CAD patients with OR = 0.66 (95%CI, 0.42, 1.05; p = 0.08) and any types of bleeding (major or minor bleeding) with overall OR = 0.81 (95%CI, 0.54, 1.21; p = 0.3) and I

conclusionThe meta-analysis of the selected articles indicated a preference for ticagrelor over clopidogrel in patients with stroke or CAD possessing CYP2C19 LOF alleles. The reduced incidence of thrombosis/embolism and associated events, such as stroke and MI, was noted in individuals administered ticagrelor in comparison to those receiving clopidogrel. Bleeding remains a concern with ticagrelor; however, current studies indicate its safety since there are no significant changes in the risk of minor and major bleeding and ICH compared to clopidogrel.

Indexed as

ClopidogrelCoronary Artery DiseaseCytochrome P-450 CYP2C19Platelet Aggregation InhibitorsStrokeTicagrelorAllelesHumansLoss of Function MutationClopidogrelCYP2C19 protein, humanCytochrome P-450 CYP2C19Platelet Aggregation InhibitorsTicagrelorClopidogrelCoronaryCYP2 C19Loss-of-functionStrokeTicagrelor

Identifiers

PMID40533625
PMCPMC12398434

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.