IntroductionStent-assisted coil embolization (SACE) for cerebral aneurysms requires dual antiplatelet therapy (DAPT), commonly clopidogrel plus aspirin is preferable to ticagrelor or prasugrel plus aspirin. However, there are few studies assessing the safety of the association of ticagrelor or prasugrel plus aspirin.ObjectivesCompare the safety of newer P2Y12 inhibitors with clopidogrel in patients that underwent a SACE for cerebral aneurysms.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed and Embase for studies comparing newer P2Y12 inhibitors with clopidogrel in patients undergoing DAPT for SACE. Outcomes were total number of complications, number of hemorrhagic complications, and number of thromboembolic complications both intraoperative and follow-up. A random effects model was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs).ResultsWe included 1026 patients from six studies. Newer P2Y12 inhibitors were used in 562 (54,77%) patients. There were no significant differences between groups in total number of complications (OR 0.80; 95% CI 0.32, 1.99; p < 0.01; I2 = 78%), in intraoperative hemorrhagic complications (OR 0.66; 95% CI 0.09, 4.71; p = 0.68; I2 = 0%), follow-up hemorrhagic complications (OR 1.23; 95% CI 0.70, 2.15; p = 0.49; I2 = 0%), intraoperative thromboembolic complications (OR 0.43; 95% CI 0.14, 1.35; p = 0.25; I2 = 24%), and in follow-up thromboembolic complications (OR 0.89; 95% CI 0.33, 2.39; p = 0.03; I2 = 59%).ConclusionIn patients who underwent a SACE, newer P2Y12 inhibitors showed no differences in intraoperative and follow-up complications compared with clopidogrel.

中文翻译：

---

氯吡格雷与新型 P2Y12 抑制剂在支架辅助弹簧圈栓塞颅内动脉瘤双重抗血小板治疗中的比较：一项荟萃分析

简介支架辅助弹簧圈栓塞术（SACE）治疗脑动脉瘤需要双重抗血小板治疗（DAPT），通常氯吡格雷加阿司匹林优于替格瑞洛或普拉格雷加阿司匹林。然而，很少有研究评估替格瑞洛或普拉格雷联合阿司匹林的安全性。目的比较新型 P2Y12 抑制剂与氯吡格雷在因脑动脉瘤接受 SACE 的患者中的安全性。方法按照系统评价和荟萃分析的首选报告项目-分析指南，我们搜索了 PubMed 和 Embase，以查找在接受 DAPT 进行 SACE 的患者中比较新型 P2Y12 抑制剂与氯吡格雷的研究。结果包括术中和随访期间的并发症总数、出血并发症数量以及血栓栓塞并发症数量。使用随机效应模型计算优势比 (OR) 和 95% 置信区间 (CI)。结果我们纳入了来自六项研究的 1026 名患者。562 名 (54.77%) 患者使用了较新的 P2Y12 抑制剂。各组间并发症总数无显着差异（OR 0.80；95% CI 0.32, 1.99；p < 0.01；I2= 78%），术中出血并发症（OR 0.66；95% CI 0.09, 4.71；p = 0.68；I2= 0%），随访出血并发症（OR 1.23；95% CI 0.70, 2.15；p = 0.49；I2= 0%），术中血栓栓塞并发症（OR 0.43；95% CI 0.14, 1.35；p = 0.25；I2= 24%），以及随访血栓栓塞并发症（OR 0.89；95% CI 0.33, 2.39；p = 0.03；I2= 59%）。结论在接受 SACE 的患者中，与氯吡格雷相比，新型 P2Y12 抑制剂在术中和随访并发症方面没有差异。