P2Y12 Antiplatelet Choice for Patients with Chronic Kidney Disease and Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
- 주제(키워드) acute coronary syndrome , antiplatelet , dual antiplatelet therapy , chronic kidney disease , hemodialysis , clopidogrel resistance , high on-treatment of platelet reactivity
- 주제(기타) Health Care Sciences & Services
- 주제(기타) Medicine, General & Internal
- 설명문(일반) [Park, Sohyun] Ewha Womans Univ, Grad Sch, Div Life & Pharmaceut Sci, Seoul 03760, South Korea; [Park, Sohyun; Kang, Ji Eun] Natl Med Ctr, Dept Pharm, Seoul 04564, South Korea; [Choi, Yeo Jin] CHA Univ, Grad Sch Clin Pharm, Seongnam 13488, South Korea; [Kang, Ji Eun; Kim, Myeong Gyu; Kim, So Dam; Rhie, Sandy Jeong] Ewha Womans Univ, Coll Pharm, Seoul 03760, South Korea; [Kim, Myeong Gyu; Jung Geum, Min; Rhie, Sandy Jeong] Ewha Womans Univ, Grad Sch Pharmaceut Sci, Seoul 03760, South Korea; [Jung Geum, Min] Yonsei Univ Hlth Syst, Severance Hosp, Dept Pharm, Seoul 03722, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 MDPI
- 발행년도 2021
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000181528
- 본문언어 영어
- Published As http://dx.doi.org/10.3390/jpm11030222
초록/요약
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.
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