Ticagrelor or Clopidogrel as Antiplatelet Agents in Patients with Chronic Kidney Disease and Cardiovascular Disease: A Meta-analysis.
Humans
Platelet Aggregation Inhibitors
/ adverse effects
Clopidogrel
/ adverse effects
Ticagrelor
/ adverse effects
Cardiovascular Diseases
/ drug therapy
Hemorrhage
/ chemically induced
Myocardial Infarction
/ drug therapy
Renal Insufficiency, Chronic
/ complications
Treatment Outcome
Percutaneous Coronary Intervention
/ adverse effects
Acute Coronary Syndrome
/ drug therapy
Journal
American journal of cardiovascular drugs : drugs, devices, and other interventions
ISSN: 1179-187X
Titre abrégé: Am J Cardiovasc Drugs
Pays: New Zealand
ID NLM: 100967755
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
accepted:
19
07
2023
medline:
29
8
2023
pubmed:
2
8
2023
entrez:
2
8
2023
Statut:
ppublish
Résumé
The worldwide prevalence of chronic kidney disease (CKD) has significantly increased in the past decades. Scientific reports have shown CKD to be an enhancing risk factor for the development of cardiovascular disease (CVD), which is the leading cause of premature death in patients with CKD. Clinical practice guidelines are ambiguous in view of the use of antiplatelet drugs in patients with CKD because patients with moderate-to-severe CKD were often excluded from clinical trials evaluating the efficacy and safety of anticoagulants and antiplatelet agents. In this analysis, we aimed to systematically assess the adverse cardiovascular and bleeding outcomes that were observed with ticagrelor versus clopidogrel use in patients with CKD and cardiovascular disease. Electronic databases including Web of Science, Google Scholar, http://www. gov , Cochrane database, EMBASE, and MEDLINE were carefully searched for English-based articles comparing ticagrelor with clopidogrel in patients with CKD. Adverse cardiovascular outcomes and bleeding events were the endpoints in this study. The latest version of the RevMan software (version 5.4) was used to analyze the data. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the data post analysis. A total of 15,664 participants were included in this analysis, whereby 2456 CKD participants were assigned to ticagrelor and 13,208 CKD participants were assigned to clopidogrel. Our current analysis showed that major adverse cardiac events (MACEs) (RR: 0.85, 95% CI: 0.71-1.03; P = 0.09), all-cause mortality (RR: 0.82, 95% CI: 0.57- 1.18; P = 0.29), cardiovascular death (RR: 0.83, 95% CI: 0.56-1.23; P = 0.35), myocardial infarction (RR: 0.87, 95% CI: 0.70-1.07; P = 0.19), ischemic stroke (RR: 0.80, 95% CI: 0.58-1.11; P = 0.18), and hemorrhagic stroke (RR: 1.06, 95% CI: 0.38-2.99; P = 0.91) were not significantly different in CKD patients who were treated with ticagrelor versus clopidogrel. Thrombolysis in myocardial infarction (TIMI)-defined minor (RR: 0.89, 95% CI: 0.52-1.53; P = 0.68) and TIMI major bleeding (RR: 1.10, 95% CI: 0.69-1.76; P = 0.67) were also not significantly different. However, bleeding defined according to the academic research consortium (BARC) bleeding type 1 or 2 (RR: 1.95, 95% CI: 1.13-3.37; P = 0.02) and BARC bleeding type 3 or 5 (RR: 1.70, 95% CI: 1.17-2.48; P = 0.006) were significantly higher with ticagrelor. When compared with clopidogrel, even though ticagrelor was not associated with higher risk of adverse cardiovascular outcomes in these patients with CKD, it was associated with significantly higher BARC bleeding. Therefore, the safety outcomes of ticagrelor still require further evaluation in patients with CKD. Nevertheless, this hypothesis should only be confirmed with more powerful results that could usually only be achieved using large-scale randomized trials.
Identifiants
pubmed: 37530990
doi: 10.1007/s40256-023-00600-w
pii: 10.1007/s40256-023-00600-w
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Clopidogrel
A74586SNO7
Ticagrelor
GLH0314RVC
Types de publication
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
533-546Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
Références
Hoerger TJ, Simpson SA, Yarnoff BO, et al. The future burden of CKD in the United States: a simulation model for the CDC CKD Initiative. Am J Kidney Dis. 2015;65(3):40311.
Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. US Department of Health and Human Services, Centers for Disease Control and Prevention. https://www.cdc.gov/kidneydisease/publications-resources/2019-nationalfacts.html . Accessed 12 Aug 2019.
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–1858.
Song K-K, Zhao D-L, Wang Y-D, et al. Analysis of factors associated with death in maintenance hemodialysis patients: a multicenter study in China. Chin Med J (Engl). 2017;130(8):885–91.
doi: 10.4103/0366-6999.204103
pubmed: 28397716
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.
Fort J. Chronic renal failure: a cardiovascular risk factor. Kidney Int Suppl. 2005;99:S25–9 (MEDLINE: 16336573).
doi: 10.1111/j.1523-1755.2005.09906.x
Shrivastava A, Nath RK, Mahapatra HS, et al. Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI). Indian Heart J. 2022;74(5):363–8.
doi: 10.1016/j.ihj.2022.08.004
pubmed: 36007555
pmcid: 9647695
Giacoppo D, Matsuda Y, Fovino LN, et al. Short dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy vs. prolonged dual antiplatelet therapy after percutaneous coronary intervention with second-generation drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials. Eur Heart J. 2021;42(4):308–19.
doi: 10.1093/eurheartj/ehaa739
pubmed: 33284979
El-Menyar A, Hussein H, Suwaidi JA. Coronary stent thrombosis in patients with chronic renal insufficiency. Angiology. 2010;61(3):297–303.
doi: 10.1177/0003319709344574
pubmed: 19689994
Jain N, Hedayati SS, Sarode R, Banerjee S, Reilly RF. Antiplatelet therapy in the management of cardiovascular disease in patients with CKD: what is the evidence? Clin J Am Soc Nephrol. 2013;8(4):665–74.
doi: 10.2215/CJN.06790712
pubmed: 23024160
Baber U, Mehran R, Kirtane AJ, et al. Prevalence and impact of high platelet reactivity in chronic kidney disease: results from the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents registry. Circ Cardiovasc Interv. 2015;8(6):e001683.
doi: 10.1161/CIRCINTERVENTIONS.115.001683
pubmed: 26056248
Sharif-Askari FS, Sulaiman SAS, Sharif-Askari NS. Anticoagulation therapy in patients with chronic kidney disease. Adv Exp Med Biol. 2017;906:101–14.
doi: 10.1007/5584_2016_109
Tagarakis GI. Ticagrelor and prasugrel: two novel, most-promising antiplatelet agents. Recent Pat Cardiovasc Drug Discov. 2010;5(3):208–11.
doi: 10.2174/157489010793351908
pubmed: 20874669
Jacobsen MR, Engstrøm T, Torp-Pedersen C, et al. Clopidogrel, prasugrel, and ticagrelor for all-comers with ST-segment elevation myocardial infarction. Int J Cardiol. 2021;342:15–22.
doi: 10.1016/j.ijcard.2021.07.047
pubmed: 34311012
Chen Y, Shaowen Tu, Chen Z, et al. Ticagrelor versus clopidogrel in patients with severe renal insufficiency undergoing PCI for acute coronary syndrome. J Interv Cardiol. 2022;31(2022):6476777.
Jain N, Phadnis MA, Hunt SL, et al. Comparative effectiveness and safety of oral p2y12 inhibitors in patients on chronic dialysis. Kidney Int Rep. 2021;6(9):2381–91.
doi: 10.1016/j.ekir.2021.06.031
pubmed: 34514199
pmcid: 8418979
James S, Budaj A, Aylward P, et al. Ticagrelor versus clopidogrel in acute coronary syndromes in relation to renal function: results from the Platelet Inhibition and Patient Outcomes (PLATO) trial. Circulation. 2010;122(11):1056–67.
doi: 10.1161/CIRCULATIONAHA.109.933796
pubmed: 20805430
Lee C-H, Tsai T-H, Lin C-J, Hsueh S-K, Chung W-J, Cheng C-I. Efficacy and safety of ticagrelor compared with clopidogrel in patients with end-stage renal disease with acute myocardial infarction. Am J Cardiovasc Drugs. 2019;19(3):325–34.
doi: 10.1007/s40256-018-00318-0
pubmed: 30746615
Li Y-S, Wang S-H, Hwang S-J, Yang Y-H, Hsieh K-P. Comparison of effectiveness and safety between ticagrelor and clopidogrel in patients with acute coronary syndrome and on dialysis in Taiwan. Br J Clin Pharmacol. 2022;88(1):145–54.
doi: 10.1111/bcp.14935
pubmed: 34080719
Mavrakanas TA, Kamal O, Charytan DM. Prasugrel and ticagrelor in patients with drug-eluting stents and kidney failure. Clin J Am Soc Nephrol. 2021;16(5):757–64.
doi: 10.2215/CJN.12120720
pubmed: 33811128
pmcid: 8259486
Roh JW, Lee S-J, Kim B-K, et al. Ticagrelor vs clopidogrel in acute coronary syndrome patients with chronic kidney disease after new-generation drug-eluting stent implantation. Front Cardiovasc Med. 2022;8:707722.
doi: 10.3389/fcvm.2021.707722
pubmed: 35083294
pmcid: 8785207
Kikkert WJ, van Geloven N, van der Laan MH, et al. The prognostic value of bleeding academic research consortium (BARC)-defined bleeding complications in ST-segment elevation myocardial infarction: a comparison with the TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications. J Am Coll Cardiol. 2014;63(18):1866–75.
doi: 10.1016/j.jacc.2014.01.069
pubmed: 24657697
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.
doi: 10.1007/s10654-010-9491-z
pubmed: 20652370
Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
doi: 10.1136/bmj.d5928
pubmed: 22008217
pmcid: 3196245
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
doi: 10.1136/bmj.n71
pubmed: 33782057
pmcid: 8005924
Lutz J, Jurk RNK. Platelets in advanced chronic kidney disease: two sides of the coin. Semin Thromb Hemost. 2020;46(3):342–56.
doi: 10.1055/s-0040-1708841
pubmed: 32259877
Xiaole S, Yan B, Wang L, Lv J, Cheng H, Chen Y. Effect of antiplatelet therapy on cardiovascular and kidney outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol. 2019;20(1):309.
doi: 10.1186/s12882-019-1499-3
Jain N, Corken A, Arthur JM, et al. Ticagrelor inhibits platelet aggregation and reduces inflammatory burden more than clopidogrel in patients with stages 4 or 5 chronic kidney disease. Vascul Pharmacol. 2023;148:107143.
doi: 10.1016/j.vph.2023.107143
pubmed: 36682595
Tung Y-C, Chang C-J, Liu J-R, Chang S-H, Chan Y-H, Kuo C-T, See L-C. Outcomes after ticagrelor versus clopidogrel treatment in end-stage renal disease patients with acute myocardial infarction: a nationwide cohort study. Sci Rep. 2021;11(1):20826.
doi: 10.1038/s41598-021-00360-0
pubmed: 34675293
pmcid: 8531372
Wu B, Lin H, Tobe RG, Zhang L, He B. Ticagrelor versus clopidogrel in East-Asian patients with acute coronary syndromes: a meta-analysis of randomized trials. J Comp Eff Res. 2018;7(3):281–91.
doi: 10.2217/cer-2017-0074
pubmed: 29094604
Park D-W, Kwon O, Jang J-S, et al. Clinically significant bleeding with ticagrelor versus clopidogrel in korean patients with acute coronary syndromes intended for invasive management: a randomized clinical trial. Circulation. 2019;140(23):1865–77.
doi: 10.1161/CIRCULATIONAHA.119.041766
pubmed: 31553203
Kang H-J, Clare RM, Gao R, et al. Ticagrelor versus clopidogrel in Asian patients with acute coronary syndrome: a retrospective analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. Am Heart J. 2015;169(6):899–905.e1.
Sun Y, Li C, Zhang L, et al. Clinical outcomes after ticagrelor and clopidogrel in Chinese post-stented patients. Atherosclerosis. 2019;290:52–8.
doi: 10.1016/j.atherosclerosis.2019.09.011
pubmed: 31568962
Palmer SC, Micco LD, Razavian M, Craig JC, et al. Effects of antiplatelet therapy on mortality and cardiovascular and bleeding outcomes in persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med. 2012;156(6):445–59.
doi: 10.7326/0003-4819-156-6-201203200-00007
pubmed: 22431677
Cho JY, Lee S-Y, Yun KH, et al. Factors related to major bleeding after ticagrelor therapy: results from the TICO trial. J Am Heart Assoc. 2021;10(7):e019630.
doi: 10.1161/JAHA.120.019630
pubmed: 33739127
pmcid: 8174385
Graham CA, Tan MK, Chew DP, et al. Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT). Heart Vessels. 2022;37(8):1291–8.
doi: 10.1007/s00380-022-02029-8
pubmed: 35089380
Gragnano F, Moscarella E, Calabro P, et al. Clopidogrel versus ticagrelor in high-bleeding risk patients presenting with acute coronary syndromes: insights from the multicenter START-ANTIPLATELET registry. Intern Emerg Med. 2021;16(2):379–87.
doi: 10.1007/s11739-020-02404-1
pubmed: 32557093
Wang Y, Yang Na, Suo M, et al. In-hospital outcomes of ticagrelor versus clopidogrel in high bleeding risk patients with acute coronary syndrome: findings from the CCC-ACS project. Thromb Res. 2022;216:43–51.
doi: 10.1016/j.thromres.2022.04.004
pubmed: 35714445
Wang H-Y, Li Yi, Xiao-Ming Xu, et al. Impact of baseline bleeding risk on efficacy and safety of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention. Chin Med J (Engl). 2018;131(17):2017–24.
doi: 10.4103/0366-6999.239306
pubmed: 30127210
Mainous AG, Tanner RJ, Shorr RI, Limacher MC. Use of aspirin for primary and secondary cardiovascular disease prevention in the United States, 2011–2012. J Am Heart Assoc. 2014;3(4):e000989.
doi: 10.1161/JAHA.114.000989
pubmed: 25023071
pmcid: 4310388
Stuntz M, Bernstein B. Recent trends in the prevalence of low-dose aspirin use for primary and secondary prevention of cardiovascular disease in the United States, 2012–2015. Prev Med Rep. 2016;28(5):183–6.