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Abstract: TH-PO431

Clinical Factors Associated with Choice of Oral P2Y12 Inhibitors (P2Y) in Chronic Dialysis

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Jain, Nishank, Little Rock VA Hospital, Little Rock, Arkansas, United States
  • Raghavan, Deepa, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Phadnis, Milind A., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Cui, Huizhong, University of Kansas Medical Center, Kansas City, Kansas, United States
  • Hunt, Suzanne L., University of Kansas Medical Center, Kansas City, Kansas, United States
  • Mahnken, Jonathan D., The University of Kansas Medical Center, Kansas City, Missouri, United States
  • Shireman, Theresa I., Brown University School of Public Health, Providence, Rhode Island, United States
  • Rasu, Rafia, University of Kansas, Kansas City, Kansas, United States
Background

Due to systematic exclusion of patients on chronic dialysis in P2Y clinical trials, risk factors associated with their choice remain unknown.

Methods

Using U.S. Renal Data System data, we identified dialysis patients who received new P2Y prescriptions, and analyzed trends in P2Y use and clinical risk factors associated with their choice using regression models.

Results

From 2011 to 2014, 36,590 ESRD patients received P2Y (95% clopidogrel, 3% prasugrel and 2% ticagrelor) with a proportional decrease in clopidogrel use, no change in prasugrel use and a proportional increase in ticagrelor use (p-for trend <0.0001, 0.61 and <0.0001). Median age was 64.0 years, 18% were ≥75 years, 54% men, 36% African American, 19% Hispanic and 93% on hemodialysis. History of atherosclerotic heart disease (ASHD) and thrombotic cardiovascular (CV) events were associated with choice of ticagrelor over clopidogrel [adjusted OR 5.43 (3.23, 9.15) and 2.13 (1.73, 2.62)] and prasugrel over clopidogrel [10.24 (6.66, 15.74) and 1.88 (1.63, 2.16)]. Severity of comorbidities and presence of diabetes mellitus were not associated with P2Y choice. Of the clinical events occuring 90-days prior to the index date of P2Y, percutaneous coronary intervention was the strongest independent factor favoring ticagrelor over others, adjusted OR 10.21 (8.09, 12.89) and 1.75 (1.32, 2.30).

Conclusion

Ticagrelor has gained popularity while prasugrel use remained unchanged in dialysis patients. In the absence of outcomes data in dialysis patients, clinicians favored use of ticagrelor over other P2Ys when patients had history of ASHD or CV events or were undergoing coronary revascularization. These findings suggest presence of channeling bias in prescribing P2Y to this patient population.

Figure showing semiannual trend in dialysis patients receiving new prescriptions for P2Y from July 2011 to December 2014

Funding

  • Private Foundation Support