Crushed/chewed administration of potent P2Y₁₂ inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis

Abstract

Crushed or chewed potent P2Y₁₂ inhibitors are commonly used in the hope of bridging the gap of platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The study aimed to investigate the efficacy and safety of this alternative oral administration strategy by performing a meta-analysis of available randomized clinical trials (RCTs). PubMed, Embase, the Cochrane Library and Web of Science medical literature databases were searched for RCTs comparing crushed/chewed vs. integral administration of loading dose potent P2Y₁₂ inhibitors in patients with STEMI undergoing pPCI with no language restrictions from inception to January 20th, 2021. The primary efficacy endpoints of high on treatment platelet reactivity (HPR) and P2Y₁₂ reaction units (PRU) at 1 hour together with safety and additional clinical endpoints were evaluated by pooled odds ratio (OR) or mean differences (MD) with 95% confidence intervals (95% CI). A total of 973 patents in six RCTs were eligible for analysis, while 876 patients present baseline and procedural characteristics. HPR and PRU at 1 hour were significantly reduced in the group receiving crushed/chewed P2Y₁₂ inhibitors compared with integral tablets (OR 0.28, 95% CI 0.16 to 0.49, P < .0001; MD −60.62, 95% CI −97.06 to −24.19, P = .001, respectively). Safety endpoints of major bleeding (OR 0.54, 95% CI 0.11 to 2.73, P = .46) and any bleeding (OR 0.84, 95% CI 0.43 to 1.64, P = .61), as well as additional clinical endpoints of cardiovascular death, myocardial infarction, and stroke were not affected by the oral administration strategy. In STEMI patients undergoing pPCI, crushed or chewed administration of potent P2Y₁₂ inhibitors are associated with enhanced early platelet inhibition and appear to be safe. The clinical profile transformed from this pharmacodynamic benefit need to be determined by further researches.

Keywords:

• Chewed
• crushed
• P2Y₁₂ inhibitor
• percutaneous coronary intervention
• ST-segment elevation myocardial infarction

Contribution statement

Chen Guo: conceptualization, data curation, formal analysis, investigation, methodology, resources, software, writing-original draft; Jin-Rui Zhao: investigation, methodology, resources; Meng-Jie Chen: data curation, methodology, software; Yue Zhang: methodology, resources; Rui-Yun Wu: methodology, resources; Qiang-Qiang Li: methodology, resources; Hong Zhao: methodology, resources; Jin Wei: conceptualization, project administration, supervision.

Disclosure statement

This work was supported by the National Natural Science Foundation of China under Grant (No. 81870298), without any conflict of interest declarations.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [81870298].