国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

Ticagrelor–Aspirin Versus Clopidogrel–Aspirin Among CYP2C19 Loss-of-Function Carriers With Minor Stroke or Transient Ischemic Attack in Relation to Renal Function: A Post Hoc Analysis of the CHANCE-2 Trial

第一作者：Anxin Wang,Xuewei Xie

通讯作者：Xia Meng,Yongjun Wang

Ticagrelor-aspirin; Clopidogrel-aspirin; Estimated glomerular filtration rate; Stroke

基本信息

2022-11-01

已发表文章

发表杂志：Annals of Internal Medicine

发表类型: Article

影响因子(IF): 51.598

PMID: 36315949 Pubmed原文链接 全文下载

主要研究背景及目的

Patients with renal dysfunction are a subpopulation characterized by ultrahigh ischemic and bleeding risk after stroke. Limited data exist as to the impact of dual antiplatelet therapy among these patients. Therefore, we aimed to investigate the effect of renal function on the efficacy and safety ticagrelor-aspirin versus clopidogrel-aspirin treatment.

方法

Renal function was evaluated by estimated glomerular filtration rate (eGFR) levels. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days, respectively.

结论

Patients with normal, rather than impaired renal function, received greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin. Primary Funding Source: Ministry of Science and Technology of the People’s Republic of China.

主要结果

Among 6,378 patients, 4,050 (63.5%) patients had normal (eGFR≥90 mL/min/1.73m2), 2,010 (31.5%) patients had mildly decreased (eGFR 60-89 mL/min/1.73m2), and 318 (5.0%) patients had moderately to severely decreased (eGFR<60 mL/min/1.73m2) renal function. The corresponding differences in recurrent stroke between ticagrelor-aspirin and clopidogrel-aspirin for normal, mildly decreased and moderately to severely decreased renal function was -2.8 percentage point (95% CI, -4.4 to -1.3 percentage point) (hazard ratio [HR], 0.63 [CI, 0.49 to 0.81]), -0.2 percentage point (CI, -2.4 to 2.0 percentage point) (HR, 0.98 [CI, 0.69 to 1.39]), and 3.7 percentage point (CI, -2.3 to 10.1 percentage point) (HR, 1.31 [CI, 0.48 to 3.55]) respectively. Rates of severe or moderate bleeding did not substantially differ by treatment assignments across eGFR categories.