Eggers test and Beggs funnel plot were performed to assess any pub lication bias phase 3 in included trials. Results Trial flowflow of included studies Twenty five completed randomized trials fulfilled the inclusion criteria and included 17,383 patients. Seven trials were excluded, mostly because they did not provide relevant out come data or did not have a control group. an eighth Inhibitors,Modulators,Libraries trial is ongoing. Study characteristics The included trials studied three patient populations NSTE ACS, STEMI and elective PCI. No studies in patients with previous Inhibitors,Modulators,Libraries stroke or PVD were identified. Each of the 25 trials was random ized and 17 had concealed allocation. allocation conceal ment was unclear in eight studies. All trials compared triple antiplatelet therapy with dual therapy.
Most trials used an intravenous GP IIbIIIa receptor antagonist as the additional antiplatelet agent. the remaining trials used clopidogrel or cilostazol as the extra agents. No triple therapy trials involved dipyridamole, tri flusal or prasugrel. Twenty trials gave concomitant hepa rin to both treatment groups. Inhibitors,Modulators,Libraries Hence, the comparison of triple versus conventional antiplatelet therapy was not confounded. No evidence of publication bias using Eggers test was present and there was no asymmetry on visual inspection of the Beggs fun nel plot. Quantitative data synthesis GP IIbIIIa inhibitors A 30% reduction in composite vascular events and MI alone were seen when GP IIbIIIa inhibitors were added to dual antiplatelet therapy in patients with NSTE ACS. a similar magnitude reduction in death was also present although this was non signifi cant due to the small number of events.
Similarly, vascu lar events and MI were reduced by 60% 70% in patients with STEMI with the addition of GP IIbIIIa inhibitors. death was also reduced by 30%. GPIIb IIIa inhibitors were significantly more effective in pre venting vascular events and MI in patients with STEMI than NSTEMI. Inhibitors,Modulators,Libraries Trends to reduced vascular events. MI and death were present for GPIIbIIIa based triple therapy in patients having elective PCI. Only six ischaemic strokes were recorded as an out come and these came from just four studies. when assessed there was no difference in ischaemic stroke between triple and dual antiplatelet therapy. Other agents Neither clopidogrel nor cilostazol, when added to dual antiplatelet Inhibitors,Modulators,Libraries therapy, had significant effects on vascular events in patients with STEMI or having elective PCI. However, the number of trials and patients in the comparisons was relatively small. Adverse events A significant selleck inhibitor increase in minor bleeding was seen with the use of GP IIbIIIa based triple therapy in patients with STEMI or having PCI.