Compared with clopidogrel–aspirin for preventing recurrent stroke or transient ischemic attack, ticagrelor–aspirin provided benefit in patients with normal but not reduced renal function, researchers report (visual abstract available). Using data from the CHANCE-2 (Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events-II) trial, the investigators looked at efficacy and safety in patients with CYP2C19 loss-of-function alleles with different renal function based on estimated glomerular filtration rate (eGFR) levels.
The post-hoc analysis evaluated primary efficacy and safety outcomes of recurrent stroke and severe or moderate bleeding within 90 days, respectively, at 202 centers in China. “Among 6378 patients, 4050 (63.5%) had normal (eGFR ≥90 mL/min/1.73 m2), 2010 (31.5%) had mildly decreased (eGFR 60 to 89 mL/min/1.73 m2), and 318 (5.0%) had moderately to severely decreased (eGFR <60 mL/min/1.73 m2) renal function,” the authors write. “The corresponding differences in recurrent stroke between ticagrelor–aspirin and clopidogrel–aspirin for normal, mildly decreased, and moderately to severely decreased renal function was −2.8 percentage points (95% CI, −4.4 to −1.3 percentage points) (hazard ratio [HR], 0.63 [CI, 0.49 to 0.81]), −0.2 percentage point (CI, −2.4 to 2.0 percentage points) (HR, 0.98 [CI, 0.69 to 1.39]), and 3.7 percentage points (CI, −2.3 to 10.1 percentage points) (HR, 1.31 [CI, 0.48 to 3.55]), respectively. Rates of severe or moderate bleeding did not substantially differ by treatment assignments across eGFR categories.”
“The findings suggest that renal function should be considered when deciding on the use of ticagrelor–aspirin versus clopidogrel–aspirin,” the investigators conclude. “Ticagrelor–aspirin, compared with clopidogrel–aspirin, substantially reduced the risk for recurrent stroke within 90 days of follow-up in patients with normal renal function, but this benefit was not apparent in those with mildly or moderately to severely decreased renal function.”