Seven RCTs were included in the review (58,591 patients). Follow-up ranged from 0.9 to 15 months.
A significant reduction in all-cause mortality (OR 0.87, 95% CI 0.79 to 0.95; Ι²=15%; seven RCTs), recurrent myocardial infarction (OR 0.80, 95% CI 0.74 to 0.87; Ι²=38%; six RCTs) and definite in-stent thrombosis (OR 0.52, 95% CI 0.43 to 0.63; Ι²=0%; four RCTs) was found with new antiplatelet regimens compared with standard-dose clopidogrel. No between group difference was found for major bleeding complications.
In subgroup analyses, a significant reduction in all-cause mortality was found for new antiplatelet drugs (OR 0.83, 95% CI 0.74 to 0.92; Ι²=36%; three RCTs) and for patients who underwent percutaneous coronary intervention (OR 0.88, 95% CI 0.78 to 0.99; Ι²=12%; four RCTs), but not for high-dose clopidogrel (600mg). A significant reduction in myocardial infarction was found for new antiplatelet drugs (OR 0.79, 95% CI 0.72 to 0.86; Ι²=55%; three RCTs) and patients who underwent percutaneous coronary intervention (OR 0.73, 95% CI 0.67 to 0.80; Ι²=30%; three RCTs), but for not high-dose clopidogrel. High-dose clopidogrel was associated with a higher rate of bleeding complications (OR 1.25, 95% CI 1.02 to 1.53; Ι²=0%; four RCTs) compared with standard dose clopidogrel. No between group differences were found for new antiplatelet drugs or percutaneous coronary intervention and 300mg clopidogrel.
No evidence of publication bias was found in the funnel plot for all-cause mortality.