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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

First author：Anxin Wang,Xuewei Xie

Corresponding author：Xia Meng,Yongjun Wang

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

essential_information

2022-11-01

Published articles

Journal：Annals of Internal Medicine

Publication type: Article

IF(IF): 51.598

PMID: 36315949 Link To Pubmed Full text Download

Background And Purpose

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.

Method

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.

Conclusion

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.

Main results

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.