P2Y12 Antiplatelet Choice for Patients with Chronic Kidney Disease and Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

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

doi:10.3390/jpm11030222

Cited by 12 publications

(16 citation statements)

References 41 publications

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“…Ticagrelor also reduced morality while major bleeding rates were also not different from clopidogrel. More recent data from RENAMI and BLEEMACS registries also supports the use of prasugrel and ticagrelor in CKD for reduction of mortality and reinfarction rates [ 50 , 51 ]. The rates of major bleeding were not increased by these potent P2Y12i therapies.…”

Section: P2y12i In Special Scenarios—ckd and Dmmentioning

confidence: 97%

Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status

Pradhan

Tiwari

Caminiti

et al. 2022

IJERPH

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Dual antiplatelet therapy (DAPT) has remained a cornerstone for management of acute coronary syndrome (ACS) over the years. Clopidogrel has been the quintessential P2Y12 receptor (platelet receptor for Adenosine 5′ diphosphate) inhibitor for the past two decades. With the demonstration of unequivocal superior efficacy of prasugrel/ticagrelor over clopidogrel, guidelines now recommend these agents in priority over clopidogrel in current management of ACS. Cangrelor has revived the interest in injectable antiplatelet therapy too. Albeit the increased efficacy of these newer agents comes at the cost of increased bleeding and this becomes more of a concern when combined with aspirin. Which P2Y12i is superior over another has been intensely debated over last few years after the ISAR-REACT 5 study with inconclusive data. Three novel antiplatelet agents are already in the pipeline of ACS with all of them succeeding in phase II studies. The search for an ideal antiplatelet remains a need of the hour for optimal reduction of ischemic events in ACS.

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Section: P2y12i In Special Scenarios—ckd and Dmmentioning

confidence: 97%

Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status

Pradhan

Tiwari

Caminiti

et al. 2022

IJERPH

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“…Существенная доля пациентов, перенесших кровотечения на фоне более интенсивной терапии, были переведены на терапию клопидогрелом. Авторы делают заключение, что у таких пациентов клопидогрел может быть предпочтительной опцией [44].…”

Section: хроническая болезнь почекunclassified

Current views on antiplatelet therapy in acute coronary syndrome patients: the place of clopidogrel

Шахматова

2022

Aterotromboz

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Clopidogrel is the most studied P2Y12 receptor blocker and still has no alternative in a number of categories of ACS patients in whom ticagrelor or prasugrel have not been studied or their use is associated with an unacceptably high risk of bleeding. The review is devoted to a detailed consideration of these clinical situations, both in the light of the evidence base for the benefits of clopidogrel andthe practical aspects of its use. Clopidogrel remains the drug of choice in ST-segment elevation ACS patients undergoing thrombolysis, pharmacoinvasive strategy is implemented, and reperfusion therapy is not used at all. In patients with ACS without ST-segment elevation, clopidogrel is preferable in high risk of bleeding. The article discusses in more detail some particular cases of high bleeding risk in ACS patients, in which it is advisable to use clopidogrel: concomitant use of oral anticoagulants, active cancer, chronic kidney disease stages IV-V. Relatively new data on the peculiarities of ACS antiplatelet therapy in the mongoloid race are discussed, which is relevantto the Russian Federation. In real clinical practice, clopidogrel is often used because of intolerance, contraindications or unavailability of more powerful P2Y12 receptor blockers. Affordability, good tolerability, greater safety (including in relation to the development of recurrent minor “annoying” bleedings), single dose clopidogrel and availability of fixed combinations with acetylsalicylic acid result in better adherence to treatment with this drug than with more powerful P2Y12 receptor blockers, which in real-world settings may provide a more optimal treatment outcome. The article discusses approaches to forced de-escalation of antiplatelet therapy – switching from a more potent P2Y12 receptor blocker to clopidogrel. Data is also presented on the study of routine de-escalation at the end of the acute ACS period, both empirical and controlled by functional or genetic tests characterizing the efficacy of clopidogrel. Although routine de-escalation is not currently recommended, randomized trials suggest that this treatment strategy is promising for preventing hemorrhagic complications and reducing the cost of managing patients with ACS.

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“…In patients with severe CKD (eGFR <30 mL/min) the risk of bleeding was significantly higher than in moderate CKD. Antiplatelet treatment with ticagrelor, prasugrel or triple therapy can considerably suppress platelet activity in patients with CKD, even in those on hemodialysis, but double dose clopidogrel does not [168]. Some patients with CKD stage 5 can benefit from shorter DAPT and others may require extended treatment, considering the risk of bleeding versus thrombosis in ESRD.…”

Section: Leukocytosismentioning

confidence: 99%

Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease

et al. 2021

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The main causes of death in patients with chronic kidney disease (CKD) are of cardiovascular nature. The interaction between traditional cardiovascular risk factors (CVRF) and non-traditional risk factors (RF) triggers various complex pathophysiological mechanisms that will lead to accelerated atherosclerosis in the context of decreased renal function. In terms of mortality, CKD should be considered equivalent to ischemic coronary artery disease (CAD) and properly monitored. Vascular calcification, endothelial dysfunction, oxidative stress, anemia, and inflammatory syndrome represents the main uremic RF triggered by accumulation of the uremic toxins in CKD subjects. Proteinuria that appears due to kidney function decline may initiate an inflammatory status and alteration of the coagulation – fibrinolysis systems, favorizing acute coronary syndromes (ACS) occurrence. All these factors represent potential targets for future therapy that may improve CKD patient’s survival and prevention of CV events. Once installed, the CAD in CKD population is associated with negative outcome and increased mortality rate, that is the reason why discovering the complex pathophysiological connections between the two conditions and a proper control of the uremic RF are crucial and may represent the solutions for influencing the prognostic. Exclusion of CKD subjects from the important trials dealing with ACS and improper use of the therapeutical options because of the declined kidney functioned are issues that need to be surpassed. New ongoing trials with CKD subjects and platelets reactivity studies offers new perspectives for a better clinical approach and the expected results will clarify many aspects.

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P2Y12 Antiplatelet Choice for Patients with Chronic Kidney Disease and Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 41 publications

Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status

Ideal P2Y12 Inhibitor in Acute Coronary Syndrome: A Review and Current Status

Current views on antiplatelet therapy in acute coronary syndrome patients: the place of clopidogrel

Framing Cause-Effect Relationship of Acute Coronary Syndrome in Patients with Chronic Kidney Disease

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