2865In-hospital switch of P2Y12 drugs in patients presenting with acute coronary syndrome: a meta-analysis of 14 observational and randomized studies including 10961 patients
Bibliographic record
Abstract
Introduction: Despite recently data published from clinical registries, efficacy and safety of switching among P2Y12 inhibitors (P2Y12i clopidogrel, prasugrel, ticagrelor) remain unclear. Thus, Purpose: We sought to assess the clinical outcomes of switching among P2Y12i versus maintaining the same regimen performing a comprehensive review and meta-analysis of available data. Methods: MEDLINE/PubMed/SCOPUS/Cochrane were systematically screened for studies regarding P2Y12i management and switching in clinical practice reporting a follow-up within 30 days. Comparisons between patients undergoing or not switching were performed reporting major cardiac events (MACE), any and major bleeding. Results: 10961 patients from 14 studies were included in the final analysis. Unstable Angina/NonST-elevation myocardial infarction [63.0%, InterQuartile Range (IQR) 42.1–72.1)] was the most common clinical presentation followed by ST-elevation myocardial infarction [37.0%, IQR 26.9–54.0)]. Total number of switch was 2851 (26%). Overall occurrence of MACE, any and major bleeding was 3.2%, 4.9% and 0.7%, respectively in the no-switching group vs. 2.2%, 3.5% and 0.5%, respectively in the switching group. There were no significant difference in MACE (OR 0.89 [95% CI 0.59–1.35]), however risk of any bleeding (OR 1.89 [95% CI 1.37–2.61) as well as major bleeding (OR 1.90 [95% CI 1.24–2.90) was higher among switched patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.020 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.043 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".