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dc.contributor.authorGagne, Joshua Jen_US
dc.contributor.authorBykov, Katsiaryanaen_US
dc.contributor.authorChoudhry, Niteesh Ken_US
dc.contributor.authorToomey, Timothy Jen_US
dc.contributor.authorConnolly, John Gen_US
dc.contributor.authorAvorn, Jerryen_US
dc.date.accessioned2014-03-10T16:16:19Z
dc.date.issued2013en_US
dc.identifier.citationGagne, Joshua J, Katsiaryana Bykov, Niteesh K Choudhry, Timothy J Toomey, John G Connolly, and Jerry Avorn. 2013. “Effect of smoking on comparative efficacy of antiplatelet agents: systematic review, meta-analysis, and indirect comparison.” BMJ : British Medical Journal 347 (1): f5307. doi:10.1136/bmj.f5307. http://dx.doi.org/10.1136/bmj.f5307.en
dc.identifier.issn0959-8138en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:11877000
dc.description.abstractObjective: To evaluate whether smoking status is associated with the efficacy of antiplatelet treatment in the prevention of cardiovascular events. Design: Systematic review, meta-analysis, and indirect comparisons. Data sources Medline (1966 to present) and Embase (1974 to present), with supplementary searches in databases of abstracts from major cardiology conferences, the Cumulative Index to Nursing and Allied Health (CINAHL) and the CAB Abstracts databases, and Google Scholar. Study selection Randomized trials of clopidogrel, prasugrel, or ticagrelor that examined clinical outcomes among subgroups of smokers and nonsmokers. Data extraction Two authors independently extracted all data, including information on the patient populations included in the trials, treatment types and doses, definitions of clinical outcomes and duration of follow-up, definitions of smoking subgroups and number of patients in each group, and effect estimates and 95% confidence intervals for each smoking status subgroup. Results: Of nine eligible randomized trials, one investigated clopidogrel compared with aspirin, four investigated clopidogrel plus aspirin compared with aspirin alone, and one investigated double dose compared with standard dose clopidogrel; these trials include 74 489 patients, of whom 21 717 (29%) were smokers. Among smokers, patients randomized to clopidogrel experienced a 25% reduction in the primary composite clinical outcome of cardiovascular death, myocardial infarction, and stroke compared with patients in the control groups (relative risk 0.75, 95% confidence interval 0.67 to 0.83). In nonsmokers, however, clopidogrel produced just an 8% reduction in the composite outcome (0.92, 0.87 to 0.98). Two studies investigated prasugrel plus aspirin compared with clopidogrel plus aspirin, and one study investigated ticagrelor plus aspirin compared with clopidogrel plus aspirin. In smokers, the relative risk was 0.71 (0.61 to 0.82) for prasugrel compared with clopidogrel and 0.83 (0.68 to 1.00) for ticagrelor compared with clopidogrel. Corresponding relative risks were 0.92 (0.83 to 1.01) and 0.89 (0.79 to 1.00) among nonsmokers. Conclusions: In randomized clinical trials of antiplatelet drugs, the reported clinical benefit of clopidogrel in reducing cardiovascular death, myocardial infarction, and stroke was seen primarily in smokers, with little benefit in nonsmokers.en
dc.language.isoen_USen
dc.publisherBMJ Publishing Group Ltd.en
dc.relation.isversionofdoi:10.1136/bmj.f5307en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775704/pdf/en
dash.licenseLAAen_US
dc.titleEffect of smoking on comparative efficacy of antiplatelet agents: systematic review, meta-analysis, and indirect comparisonen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalBMJ : British Medical Journalen
dash.depositing.authorGagne, Joshua Jen_US
dc.date.available2014-03-10T16:16:19Z
dc.identifier.doi10.1136/bmj.f5307*
dash.contributor.affiliatedConnolly, John
dash.contributor.affiliatedChoudhry, Niteesh
dash.contributor.affiliatedAvorn, Jerome
dash.contributor.affiliatedGagne, Joshua


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