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P2Y12 Antiplatelet Choice for Patients with Chronic Kidney Disease and Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
- Title
- P2Y12 Antiplatelet Choice for Patients with Chronic Kidney Disease and Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
- Authors
- Park, Sohyun; Choi, Yeo Jin; Kang, Ji Eun; Kim, Myeong Gyu; Jung Geum, Min; Kim, So Dam; Rhie, Sandy Jeong
- Ewha Authors
- 이정연; 강지은; 김명규
- SCOPUS Author ID
- 이정연; 강지은; 김명규
- Issue Date
- 2021
- Journal Title
- JOURNAL OF PERSONALIZED MEDICINE
- ISSN
- 2075-4426
- Citation
- JOURNAL OF PERSONALIZED MEDICINE vol. 11, no. 3
- Keywords
- acute coronary syndrome; antiplatelet; dual antiplatelet therapy; chronic kidney disease; hemodialysis; clopidogrel resistance; high on-treatment of platelet reactivity
- Publisher
- MDPI
- Indexed
- SCIE; SCOPUS
- Document Type
- Review
- Abstract
- 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.
- DOI
- 10.3390/jpm11030222
- Appears in Collections:
- 약학대학 > 약학과 > Journal papers
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