Effects of clopidogrel on mortality, cardiovascular and bleeding outcomes in patients with chronic kidney disease - data from Taiwan acute coronary syndrome full spectrum registry

• Published in: PloS one Vol. 8; no. 8; p. e71917
• Main Authors: Lin, Tsung-Hsien, Lai, Wen-Ter, Hsin, Ho-Tsung, Li, Ai-Hsien, Wang, Chun-Li, Kuo, Chi-Tai, Hwang, Juey-Jen, Chiang, Fu-Tien, Chang, Shu-Chen
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28.08.2013; Public Library of Science (PLoS)
• Subjects: Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Aged; Aged, 80 and over; Antiplatelet therapy; Bleeding; Blood platelets; Cardiology; Cardiovascular disease; Cardiovascular diseases; Cerebral infarction; Clopidogrel; Drug dosages; Female; Glomerular filtration rate; Health risks; Heart attacks; Hemorrhage - chemically induced; Hospitals; Humans; Infarction; Internal medicine; Intervention; Kaplan-Meier Estimate; Kidney diseases; Kidney transplantation; Male; Medicine; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - prevention & control; Patients; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - pharmacology; Platelet Aggregation Inhibitors - therapeutic use; Proportional Hazards Models; Prospective Studies; Registries; Regression analysis; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - mortality; Risk; Risk reduction; Stroke; Systematic review; Taiwan; Thrombolysis; Ticlopidine - adverse effects; Ticlopidine - analogs & derivatives; Ticlopidine - pharmacology; Ticlopidine - therapeutic use; Treatment Outcome; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0071917

The efficacy of clopidogrel is inconclusive in the chronic kidney disease (CKD) population with acute coronary syndrome (ACS). Furthermore, CKD patients are prone to bleeding with antiplatelet therapy. We investigated the efficacy and safety of clopidogrel in patients with ACS and CKD. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m(2). The primary endpoints are the combined outcomes of death, non-fatal myocardial infarction and stroke at 12 months. Overall 949 (33.7%) patients had CKD and 2660 (94.36%) patients received clopidogrel treatment. CKD is associated with increased risk of the primary endpoint at 12 months (HR 2.39, 95% CI 1.82 to 3.15, p<0.01). Clopidogrel use is associated with reduced risk of the primary endpoint at 12 months (HR 0.42, 95% CI: 0.29-0.60, p<0.01). Cox regression analysis showed that clopidogrel reduced death and primary endpoints for CKD population (HR 0.35, 95% CI: 0.21-0.61 and HR 0.48, 95% CI: 0.30-0.77, respectively, both p<0.01). Patients with clopidogrel(-)/CKD(-), clopidogrel(+)/CKD(+) and clopidogrel(-)/CKD(+) have 2.4, 3.0 and 10.4 fold risk to have primary endpoints compared with those receiving clopidogrel treatment without CKD (all p<0.01). Clopidogrel treatment was not associated with increased in-hospital Thrombolysis In Myocardial Infarction (TIMI) bleeding in CKD population. Clopidogrel could decrease mortality and improve cardiovascular outcomes without increasing risk of bleeding in ACS patients with CKD.