Background And Objectives: Prasugrel and ticagrelor have superior efficacy compared with clopidogrel in moderate CKD but have not been studied in kidney failure. The study objective is to determine the effectiveness and safety of prasugrel and ticagrelor in kidney failure.
Design, Setting, Participants, & Measurements: This retrospective cohort study used United States Renal Data System data from 2012 to 2015. We identified all patients on dialysis who received a drug-eluting stent and were alive at 90 days after stent implantation. Inverse probability-weighted Cox proportional hazard models were used. Weights were estimated with propensity scores for multiple treatments.
Results: This cohort included 6648 patients on clopidogrel, 621 on prasugrel, and 449 on ticagrelor. A total of 3279 primary composite (cardiovascular death, myocardial infarction, or stroke) and 2120 clinically relevant bleeding events were observed. The incidence of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke at 12 months was similar across the three treatment groups. The absolute event rate in the unweighted cohort was 144 events per 100 patient-years for clopidogrel, 126 for prasugrel, and 161 for ticagrelor. For prasugrel versus clopidogrel, the weighted hazard ratio was 0.96 (95% confidence interval, 0.82 to 1.11; =0.58). For ticagrelor versus clopidogrel, the hazard ratio was 1.00 (95% confidence interval, 0.83 to 1.20; =0.98). A numerically higher incidence of clinically relevant bleeding was seen with prasugrel or ticagrelor compared with clopidogrel (weighted hazard ratio, 1.15; 95% confidence interval, 0.95 to 1.38 and weighted hazard ratio, 1.13; 95% confidence interval, 0.91 to 1.40, respectively).
Conclusions: Prasugrel or ticagrelor does not seem to be associated with significant benefits compared with clopidogrel in patients with kidney failure treated with drug-eluting stents.
Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2021_04_02_CJN12120720.mp3.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259486 | PMC |
| http://dx.doi.org/10.2215/CJN.12120720 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Intracranial hemorrhagic events associated with flow diversion treatment: a retrospective analysis from a single academic institution.
Neurosurg Rev
January 2025
Neurosurgical Service, Harvard Medical School, Beth Israel Deaconess Medical Center, 110 Francis Street, Boston, MA, 02215, USA.
Intracranial hemorrhages are highly concerning but underreported complications related to flow diversion (FD) treatment of intracranial aneurysms. Herein, we aimed to characterize these complications and the factors influencing their occurrence. We retrospectively reviewed patients treated with FD from 2013 to 2023 at a single U.
View Article and Find Full Text PDFMaintenance therapy with a P2Y12 receptor inhibitor after cangrelor in patients with acute coronary syndrome. The ELECTRA-SIRIO 2 investigators' viewpoint.
Cardiol J
January 2025
Department of Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
According to the ESC guidelines, cangrelor may be considered in P2Y12-inhibitor-naïve acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The aim of this review is to summarize available evidence on the optimal maintenance therapy with P2Y12 receptor inhibitor after cangrelor. Transitioning from cangrelor to a thienopyridine, but not ticagrelor, can be associated with a drug-drug interaction (DDI); therefore, a ticagrelor loading dose (LD) can be given any time before, during, or at the end of a cangrelor infusion, while a LD of clopidogrel or prasugrel should be administered at the time the infusion of cangrelor ends or within 30 minutes before the end of infusion in the case of a LD of prasugrel.
View Article and Find Full Text PDFManaging thrombosis risk in flow diversion: A review of antiplatelet approaches.
Neuroradiol J
January 2025
Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, USA.
Flow diversion is a transformative approach in neurointerventional surgery for intracranial aneurysms that relies heavily on effective antiplatelet therapy. The ideal approach, including the timing of treatment, the use of dual antiplatelet therapy (DAPT), and the number of flow-diverter devices to use, remains unknown. DAPT, which combines aspirin with a thienopyridine like clopidogrel, prasugrel, or ticagrelor, is the standard regimen, balancing thromboembolic protection and hemorrhagic risk.
View Article and Find Full Text PDFBackground: Antiplatelet drugs, such as clopidogrel, ticagrelor, prasugrel, and acetylsalicylic acid, may be associated with a risk of adverse events (AEs). Vanessa's Law was enacted to strengthen regulations to protect Canadians from drug-related side effects (with mandatory reporting of serious adverse events [SAEs]).
Objective: To determine whether Vanessa's Law has led to an increase in SAE reporting among antiplatelet users.
Comparative Efficacy and Safety of Different Low-Dose Platelet Inhibitors in Patients With Coronary Heart Disease: A Bayesian Network Meta-Analysis.
J Evid Based Med
December 2024
Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China.
Objective: The optimal low-dose antiplatelet agents in patients with coronary heart disease (CHD) had not been determined. The objective of this study was to compare the impact of different low-dose antiplatelet agents on cardiovascular outcomes and bleeding risks in patients with CHD.
Methods: We searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, VIP, WanFang Data, and China Biology Medicine.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!