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

被引:14
作者
Park, Sohyun [1 ,2 ]
Choi, Yeo Jin [3 ]
Kang, Ji Eun [2 ,4 ]
Kim, Myeong Gyu [4 ,5 ]
Jung Geum, Min [5 ,6 ]
Kim, So Dam [4 ]
Rhie, Sandy Jeong [4 ,5 ]
机构
[1] Ewha Womans Univ, Grad Sch, Div Life & Pharmaceut Sci, Seoul 03760, South Korea
[2] Natl Med Ctr, Dept Pharm, Seoul 04564, South Korea
[3] CHA Univ, Grad Sch Clin Pharm, Seongnam 13488, South Korea
[4] Ewha Womans Univ, Coll Pharm, Seoul 03760, South Korea
[5] Ewha Womans Univ, Grad Sch Pharmaceut Sci, Seoul 03760, South Korea
[6] Yonsei Univ Hlth Syst, Severance Hosp, Dept Pharm, Seoul 03722, South Korea
来源
JOURNAL OF PERSONALIZED MEDICINE | 2021年 / 11卷 / 03期
基金
新加坡国家研究基金会;
关键词
acute coronary syndrome; antiplatelet; dual antiplatelet therapy; chronic kidney disease; hemodialysis; clopidogrel resistance; high on-treatment of platelet reactivity; PLATELET INHIBITION; CLOPIDOGREL; TICAGRELOR; RESPONSIVENESS; HEMODIALYSIS; VARIABILITY; REACTIVITY; PRASUGREL; IMPACT;
D O I
10.3390/jpm11030222
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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.
引用
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页数:14
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