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Abstract: FR-PO1039

Prasugrel and Ticagrelor in Patients with Drug-Eluting Stents and ESRD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Mavrakanas, Thomas, Brigham & Women's Hospital, Harvard Medical School, Boston, United States
  • Charytan, David M., New York University School of Medicine, Bronx, New York, United States
Background

Prasugrel and ticagrelor have superior efficacy compared with clopidogrel in patients with preserved renal function. No randomized or cohort data exist with respect to their efficacy or safety in patients with end-stage renal disease (ESRD).

Methods

This retrospective cohort study used United States Renal Data System data from 2012 to 2015. We identified all dialysis patients who received a drug-eluting stent (DES) and were alive at 90 days after DES insertion. Prasugrel or ticagrelor users were matched 1:3 to patients treated with clopidogrel according to a propensity score. Outcomes were ascertained at 12 months. Competing risk survival models were used.

Results

Compared with clopidogrel, prasugrel or ticagrelor use was not associated with reduced risk of the composite outcome of cardiovascular mortality, myocardial infarction, or stroke: adjusted hazard ratio (HR) 0.91, 95% confidence interval (CI) 0.80-1.02 for prasugrel and HR 0.93, 95% CI 0.82-1.07 for ticagrelor. Ticagrelor use was associated with lower all-cause mortality and prasugrel use was associated with lower incidence of stroke, compared with clopidogrel. There was no difference in the incidence of fatal/intracranial or clinically-significant bleeding with either of the newer antiplatelet agents, compared with clopidogrel (Table). Shorter duration of the antiplatelet agent and acute coronary syndrome at presentation were independently associated with worse prognosis.

Conclusion

This is the first study examining clinical outcomes with prasugrel or ticagrelor in ESRD. Although no major efficacy benefit was detected, both prasugrel and ticagrelor were well-tolerated in patients with ESRD and may be considered in selected cases.
Disclaimer The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US government.

Clinical outcomes with prasugrel and ticagrelor, compared with clopidogrel in patients with DES and ESRD
OutcomePrasugrel vs. clopidogrelTicagrelor vs. clopidogrel
HR (95% CI)pHR (95% CI)p
CV death, MI, stroke0.91 (0.80-1.02)0.120.93 (0.82-1.07)0.31
CV death1.01 (0.81-1.27)0.910.88 (0.69-1.12)0.30
MI0.98 (0.83-1.14)0.751.03 (0.87-1.22)0.74
Stroke0.76 (0.64-0.91)0.0031.03 (0.86-1.23)0.74
All-cause mortality0.86 (0.72-1.03)0.100.84 (0.70-0.99)0.047
Fatal-intracranial bleeding1.01 (0.59-1.72)0.970.82 (0.43-1.57)0.55
Clinically-significant bleeding1.10 (0.94-1.28)0.241.10 (0.93-1.30)0.27