Effect of Estimated Glomerular Filtration Rate Decline on the Efficacy and Safety of Clopidogrel With Aspirin in Minor Stroke or Transient Ischemic Attack

Zhou, Yilun; Pan, Yuesong; Wu, Yu; Zhao, Xingquan; Li, Hao; Wang, David; Liu, Liping; Wang, Chunxue; Meng, Xia; Wang, Yilong

doi:10.1161/strokeaha.116.014761

Cited by 17 publications

(14 citation statements)

References 32 publications

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“…In a post hoc analysis of the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial in which these patients were randomized to clopidogrel-aspirin or aspirinalone treatment, patients with moderate CKD (defined as eGFR <60 ml/min per 1.73 m 2 ; majority stage 3) treated with combination therapy did not experience a reduction in early recurrent stroke (HR, 1.00; 95% CI, 0.43-2.35; P ¼ 0.99). 100 The CHANCE trial investigators later demonstrated that carriage of the CYP2C19 loss-of-function allele (a genetic polymorphism for clopidogrel resistance) was associated with a significantly increased risk of stroke, ischemic stroke, and combined vascular events in patients on dual antiplatelet therapy with an eGFR of <75 ml/min per 1.73 m 2 . 101 The choice of antiplatelet agents or combination therapy may be important.…”

Section: Antiplateletsmentioning

confidence: 99%

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Kelly

Rothwell

2020

Kidney International

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Chronic kidney disease is strongly associated with an increased risk of stroke, small vessel disease, and vascular dementia. Common vascular factors for stroke, such as hypertension, diabetes, and atrial fibrillation, are more prevalent in patients with chronic kidney disease, accounting for this association. However, factors unique to these patients, such as uremia, oxidative stress, and mineral and bone abnormalities, as well as dialysis-related factors are also believed to contribute to risk. Despite improvements in stroke treatment and survival in the general population, the rate of improvement in patients with chronic kidney disease, especially those who are dialysis dependent, has lagged behind. There is a lack of or conflicting evidence that those with renal disease, particularly when advanced or older, consistently derive benefit from currently available preventive and therapeutic interventions for stroke in the general population. In this review, we explore the complexities and challenges of these interventions in the population with renal disease.

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Section: Antiplateletsmentioning

confidence: 99%

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Kelly

Rothwell

2020

Kidney International

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“…Ischemic brain tissue can be irreversibly damaged in a short time and cause systemic reactions ( 9 – 12 ). The key point of clinically treating ICVD is to open the occluded vessels as soon as possible, so as to restore blood flow to the brain to improve the patient's prognosis ( 13 , 14 ). Main treatment of ICVD, including thrombolysis, fibrinolysis, anticoagulant, anti-platelet aggregation and other drug treatment, usually provide poor treatment outcomes ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic effect of vascular interventional therapy and aspirin combined with defibrase on cerebral ischemia in rats

Geng

Dai

2018

Exp Ther Med

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Therapeutic effect of vascular interventional therapy and aspirin combined with defibrase in the treatment of cerebral ischemia in rat model were investigated. Ninety rats were selected to establish cerebral ischemia model. Animal models were randomly divided into observation group and control group, with 45 rats in each group. Rats in observation group were treated with vascular intervention, and control group was treated with aspirin combined with defibrase. Peak systolic velocity (Vs) and end-diastolic velocity (Vd) were compared between two groups before and after 12 months of treatment. Therapeutic effects were compared before and after 6 months, and before and after 12 months of treatment. Vs and Vd of vascular lesions in observation group at 12 months were reduced after treatment, and were significantly lower than those in control group (p<0.05). After treatment, Vs and Vd in observation group were significantly reduced (p<0.05). There was no significant difference in Vs and Vd values between the groups before treatment (p>0.05). NDS scores in observation group were significantly lower than those in control group at 6 months and 1 year after treatment (p<0.05). There were no significant changes in NDS score at 6 and 12 months after treatment in control group compared with pretreatment group (p>0.05). NDS in observation group was significantly reduced at 6 and 12 months after treatment compared with pretreatment level (p<0.05). One year after treatment, incidence of cerebral infarction and transient ischemic attack and mortality in observation group were significantly lower than those in the control group (p<0.05). Intracranial vascular interventional therapy can achieve satisfactory outcomes in the treatment of cerebral ischemia, and can effectively promote nerve function recovery, and reduce the incidence of cerebrovascular diseases and mortality.

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“…Specific recommendations for antiplatelet therapy for patients with both ischaemic stroke and CKD are limited. In a subgroup analysis of the CHANCE study, clopidogrel plus aspirin could reduce new stroke in patients with eGFR ≥90 ml/min/1.73 m 2 and eGFR 60–89 ml/min/1.73 m 2 . However, no benefit was found in those with eGFR <60 ml/min/1.73 m 2 .…”

Section: Discussionmentioning

confidence: 96%

Antiplatelet agents for the secondary prevention of ischaemic stroke in patients with or without renal dysfunction

Wang

Yen

Guo

et al. 2019

Euro J of Neurology

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Background and purpose Studies on using antiplatelet agents for secondary prevention in ischaemic stroke patients with renal dysfunction are limited. The Taiwan Stroke Registry database was used to compare the efficacy of antiplatelet agents. Methods From the Taiwan Stroke Registry data, 39 174 acute ischaemic stroke patients were identified and were classified into three groups by antiplatelet agent: aspirin, clopidogrel and dual antiplatelet therapy (DAPT) with a combination of aspirin and clopidogrel. The re‐stroke incidence and 1‐year mortality were stratified by estimated glomerular filtration rate (eGFR) levels at admission: ≥90, 60–89 and <60 ml/min/1.73 m2 or on dialysis. Results Compared to the aspirin group, the re‐stroke differences were not statistically significant for the clopidogrel group [adjusted subhazard ratio 0.95, 95% confidence interval (CI) 0.84–1.08] and the DAPT group (adjusted subhazard ratio 1.03, 95% CI 0.77–1.39) after controlling for the competing risk of death. The mortality rate increased as the eGFR level declined. In addition, compared to patients taking aspirin, there was no statistically significant difference in overall 1‐year mortality for the clopidogrel group (adjusted hazard ratio 1.11, 95% CI 0.95–1.29) and for the DAPT group (adjusted hazard ratio 1.01, 95% CI 0.67–1.54). The results were consistent in different subgroups stratified by eGFR levels. Conclusions There was no difference in the risks of recurrent stroke and 1‐year mortality amongst ischaemic stroke patients with or without renal dysfunction receiving antiplatelet agents with aspirin, clopidogrel or dual agents with a combination of aspirin and clopidogrel, regardless of their renal dysfunction status.

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Effect of Estimated Glomerular Filtration Rate Decline on the Efficacy and Safety of Clopidogrel With Aspirin in Minor Stroke or Transient Ischemic Attack

Cited by 17 publications

References 32 publications

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines

Therapeutic effect of vascular interventional therapy and aspirin combined with defibrase on cerebral ischemia in rats

Antiplatelet agents for the secondary prevention of ischaemic stroke in patients with or without renal dysfunction

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