Comparative Effectiveness and Safety of Oral P2Y12 Inhibitors in Patients on Chronic Dialysis.
Comparative Effectiveness and Safety of Oral P2Y12 Inhibitors in Patients on Chronic Dialysis.
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DOI：
10.1016/j.ekir.2021.06.031
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发表时间：
2021-09
影响因子：
6
通讯作者：
Hedayati SS
中科院分区：
文献类型：
--
作者：
Jain N;Phadnis MA;Hunt SL;Dai J;Shireman TI;Davis CL;Mehta JL;Rasu RS;Hedayati SS
虽然口服P2 Y12抑制剂（P2 Y12-Is）是终末期肾病透析（ESKD）患者最常用的处方药物之一，但关于其获益和风险的数据很少。我们在一项纵向研究中比较了氯吡格雷、普拉格雷和替格瑞洛的有效性和安全性，该研究使用了美国肾脏数据系统登记的ESKD医疗保险受益人。在2011年至2015年期间填写新P2 Y12-I处方的个人被纳入并随访至死亡或删失。主要暴露变量为P2 Y12-I分配。主要结局变量为死亡。次要结局包括心血管（CV）死亡、冠状动脉血运重建和胃肠道（GI）出血。在倾向匹配后进行生存分析。在接受P2 Y12-Is治疗的44，619例ESKD患者中，95%接受氯吡格雷（n = 42，523）、3%普拉格雷（n = 1205）和2%替格瑞洛（n = 891）。为了平衡基线差异，进行了倾向匹配：普拉格雷（n = 1189）与氯吡格雷（n = 7134）为1：6;替格瑞洛（n = 880）与氯吡格雷（n = 3520）为1：4;替格瑞洛与普拉格雷（n = 880）为1：1。与氯吡格雷和替格瑞洛相比，普拉格雷与死亡风险降低相关（校正风险比[HR] = 0.82; 95% CI：0.73-0.93和0.78; 95% CI：0.64-0.95）。与氯吡格雷相比，普拉格雷降低了冠状动脉血运重建的风险（HR = 0.91; 95% CI：0.86-0.96）。P2 Y12-Is之间的GI出血没有差异。在ESKD患者中，普拉格雷与其他药物相比降低了死亡风险，可能是通过降低冠状动脉血运重建的风险，而没有加重胃肠道出血。未来的试验必须比较P2 Y12-Is在ESKD患者中的疗效和安全性。
Although oral P2Y12 inhibitors (P2Y12-Is) are one of the most commonly prescribed medication classes in patients with end stage kidney disease on dialysis (ESKD), scarce data exist regarding their benefits and risks. We compared effectiveness and safety of clopidogrel, prasugrel, and ticagrelor in a longitudinal study using the United States Renal Data System registry of Medicare beneficiaries with ESKD. Individuals who filled new P2Y12-I prescriptions between 2011 and 2015 were included and followed until death or censoring. The primary exposure variable was P2Y12-I assignment. The primary outcome variable was death. Secondary outcomes included cardiovascular (CV) death, coronary revascularization, and gastrointestinal (GI) hemorrhage. Survival analyses were performed after propensity matching. Of 44,619 patients with ESKD who received P2Y12-Is, 95% received clopidogrel (n = 42,523), 3% prasugrel (n = 1205), and 2% ticagrelor (n = 891). To balance baseline differences, propensity-matching was performed: 1:6 for prasugrel (n = 1189) versus clopidogrel (n = 7134); 1:4 for ticagrelor (n = 880) versus clopidogrel (n = 3520); and 1:1 for ticagrelor versus prasugrel (n = 880). Prasugrel was associated with a reduced risk for death versus clopidogrel and ticagrelor (adjusted hazard ratio [HR] = 0.82; 95% CI: 0.73–0.93 and 0.78; 95% CI: 0.64–0.95). Compared with clopidogrel, prasugrel reduced risk for coronary revascularization (HR = 0.91; 95% CI: 0.86–0.96). There were no differences in GI hemorrhage between P2Y12-Is. In patients with ESKD, prasugrel compared with others reduced risk of death possibly by reducing risk for coronary revascularizations and without worsening gastrointestinal hemorrhage. Future trials are imperative to compare efficacy and safety of P2Y12-Is in patients with ESKD.
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