P2Y12 antiplatelet choice for patients with chronic kidney disease and acute coronary syndrome: A systematic review and meta-analysis

Sohyun Park, Yeo Jin Choi, Ji Eun Kang, Myeong Gyu Kim, Min Jung Geum, So Dam Kim, Sandy Jeong Rhie

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

This study aims to evaluate potentially appropriate antiplatelet therapy in patients with chronic kidney disease. A systematic analysis was conducted to identify the clinical outcomes of available antiplatelet therapy regimens with enhanced platelet inhibition activity (intervention of 5 regimens) over the standard dose of clopidogrel-based dual antiplatelet therapy in patients with renal insufficiency. An electronic keyword search was performed on Pubmed, Embase, and Cochrane Library per PRISMA guidelines. We performed a prespecified net clinical benefit analysis (a composite of the rates of all-cause or cardiac-related death, myocardial infarction, major adverse cardiac outcomes, and minor and major bleeding), and included 12 studies. The intervention substantially lowered the incidence of all-cause mortality (RR 0.67; p = 0.003), major adverse cardiac outcomes (RR 0.79; p < 0.00001), and myocardial infarction (RR 0.28; p = 0.00007) without major bleeding (RR 1.14; p = 0.33) in patients with renal insufficiency, but no significant differences were noticed with cardiac-related mortality and stent thrombosis. The subgroup analysis revealed substantially elevated bleeding risk in patients with severe renal insufficiency or on hemodialysis (RR 1.68; p = 0.002). Our study confirmed that the intervention considerably enhances clinical outcomes in patients with renal insufficiency, however, a standard dose of clopidogrel-based antiplatelet therapy is favorable in patients with severe renal insufficiency.

Original languageEnglish
Article number222
JournalJournal of Personalized Medicine
Volume11
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Acute coronary syndrome
  • Antiplatelet
  • Chronic kidney disease
  • Clopidogrel resistance
  • Dual antiplatelet therapy
  • Hemodialysis
  • High on-treatment of platelet reactivity
  • P2Y12 inhibitors

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