Risk of bradyarrhythmia related to ticagrelor: A systematic review and meta-analysis.

Pharmacological Research : the Official Journal of the Italian Pharmacological Society
Iris PujadeFrancesco Salvo

Abstract

Ticagrelor was related to bradycardia in DISPERSE-II trial. This risk has been integrated into the European risk-management plan, and its use is warned in at-risk patients. Nevertheless, this risk was not systematically assessed nor measured. To estimate the risk of bradyarrhythmia associated with ticagrelor. Systematic review and meta-analysis. MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ISI web of Science, clinicaltrial.gov, clinicaltrialsregister.eu. Randomized controlled trials (RCTs) and observational studies in patients treated with ticagrelor or comparator(s). Risk of bias in each RCT was assessed using Cochrane tool. Relative Risks (RR) with 95 % confidence intervals (95 %CI) were calculated for each RCT, and pooled using fixed-effect or random-effects models, when appropriate. Subgroup and sensitivity analyses were performed. A potential publication bias was searched. Among 82 eligible studies, event data were missing for 56 studies, due to detected reporting bias (i.e. inability to confirm zero events). Fifteen RCTs were selected and the combined RR of bradyarrhythmia was 1.15 (95 %CI 1.05-1.26), and 1.29 (1.02-1.65) for severe bradyarrhythmia. The risk appeared to be dose dependent. Restricting t...Continue Reading

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