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Clopidogrel Versus Aspirin as Chronic Maintenance Antiplatelet Monotherapy in Patients After Percutaneous Coronary Intervention With Chronic Kidney Disease: A Post Hoc Analysis of the HOST-EXAM Trial.
J Am Heart Assoc
September 2024
Department of Internal Medicine, Cardiovascular Center Seoul National University Hospital Seoul South Korea.
Background: Clopidogrel monotherapy improved clinical outcomes compared with aspirin monotherapy during a chronic maintenance period in patients who underwent coronary stenting in the HOST-EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis-Extended Antiplatelet Monotherapy) trial. However, it is uncertain whether the beneficial effect of clopidogrel over aspirin is different according to the renal function.
Methods And Results: We conducted a post hoc analysis of the HOST-EXAM trial.
Precision Antiplatelet Therapy after Percutaneous Coronary Intervention (Precision PCI) Registry - Informing optimal antiplatelet strategies.
Clin Transl Sci
August 2024
Division of Cardiology, Department of Medicine, College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida, USA.
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y receptor inhibitor (clopidogrel, prasugrel, or ticagrelor) is indicated after percutaneous coronary intervention (PCI) to reduce the risk of atherothrombotic events. Approximately 30% of the US population has a CYP2C19 no-function allele that reduces the effectiveness of clopidogrel, but not prasugrel or ticagrelor, after PCI. We have shown improved outcomes with the integration of CYP2C19 genotyping into clinical care to guide the selection of prasugrel or ticagrelor in CYP2C19 no-function allele carriers.
View Article and Find Full Text PDFEvaluating the Effect of Estimating Renal Function With the CKD-EPI 2021 Equation on the ABCD-GENE Score for Clopidogrel Response Prediction.
Clin Pharmacol Ther
November 2024
Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
The ABCD-GENE score was developed to predict poor response to clopidogrel and includes Age, Body mass index, Chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m), Diabetes, and CYP2C19 GENE variants; a score ≥ 10 is predictive of reduced clopidogrel effectiveness after percutaneous coronary intervention (PCI). Estimation of GFR without a race variable via the CKD-EPI Scr 2021 equation is now recommended.
View Article and Find Full Text PDFOne-Month Versus Three-Month Dual-Antiplatelet Therapy in High Bleeding Risk Patients With Chronic Kidney Disease.
Am J Cardiol
August 2024
Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address:
Article Synopsis
- Shortening dual-antiplatelet therapy (DAPT) to 1 month after percutaneous coronary intervention (PCI) is effective and safe for high bleeding risk (HBR) patients, regardless of chronic kidney disease (CKD) status.
- A study analyzed data from 3 prospective studies involving 3,286 patients, of whom 43.6% had CKD, comparing outcomes between 1-month and 3-month DAPT.
- Results indicated that both durations had similar rates of death and myocardial infarction after 12 months, with a slight trend for fewer bleeding complications at 1 month compared to 3 months in both CKD and no-CKD groups.
Ticagrelor in Clopidogrel-Treated Patients With Chronic Coronary Syndrome Undergoing PCI: Translating Pharmacodynamic Into Clinical Evidence.
JACC Cardiovasc Interv
June 2024
Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA. Electronic address:
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