Systematic Review of Efficacy and Safety of Low-dose Versus Standard-dose Ticagrelor in Chinese Patients with Acute Coronary Syndrome

OBJECTIVE To systematically evaluate the efficacy and safety of low-dose versus standard-dose ticagrelor in Chinese patients with acute coronary syndrome(ACS). METHODS Systematically searched databases of MEDLINE, EMBASE, Cochrane's Library, CNKI, CQVIP and Wanfang for randomized controlled trials(RCTs) comparing low-dose versus standard-dose ticagrelor in Chinese patients with ACS from the establishment of each database to March 2022. Meta-analysis was conducted for the incidence of efficacy endpoints and safety endpoints by using Rev Man 5.3 statistical software after data extraction and quality evaluation with Cochrane system evaluator manual 5.2.0. RESULTS Seventeen RCTs involving 2 225 patients were included for our meta-analysis. Compared with standard-dose of ticagrelor, low-dose of ticagrelor did not increase the risk of cardiovascular deathRR=1.01, 95%CI(0.55, 1.87), P=0.96, myocardial infarctionRR=1.24, 95%CI(0.66, 2.30), P=0.50 and strokeRR=1.43, 95%CI(0.48, 4.28), P=0.53, but significantly reduced the risk of bleedingRR=0.42, 95%CI(0.35, 0.51), P<0.000 01, major bleedingRR=0.45, 95%CI(0.26, 0.78), P=0.004, minor or minimal bleedingRR=0.43, 95%CI (0.35, 0.54), P<0.000 01 and dyspneaRR=0.52, 95% CI(0.37, 0.73), P=0.000 2. CONCLUSION Low-dose ticagrelor can significantly reduce the risk of bleeding events without increasing the risk of ischemic events in Chinese patients with ACS, which could be used as an alternative strategy for antiplatelet therapy. However, comprehensive evaluation is still needed in combination with the individual situation of patients and needs to be verified by RCT with a larger sample size.