Benefit of Ticagrelor-Aspirin in Stroke Patients Tied to Renal Function

TUESDAY, Nov. 1, 2022 (HealthDay News) — Among CYP2C19 loss-of-function allele carriers with minor stroke or transient ischemic attack, those with normal renal function rather than impaired renal function derive greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin, according to research published online Nov. 1 in the Annals of Internal Medicine.

Anxin Wang, Ph.D., from Beijing Tiantan Hospital and Capital Medical University, and colleagues examined the effect of renal function on the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin treatment in a post hoc analysis of a randomized trial conducted at 202 centers in China. Data were included for 6,378 patients: 63.5, 31.5, and 5.0 percent had normal, mildly decreased, and moderately to severely decreased renal function (estimated glomerular filtration rates, ≥90, 60 to 89, and <60 mL/min/1.73 m², respectively).

The researchers found that for normal, mildly decreased, and moderately to severely decreased renal function, the differences in recurrent stroke between ticagrelor-aspirin and clopidogrel-aspirin were −2.8 percent (hazard ratio, 0.63; 95 percent confidence interval, 0.49 to 0.81), −0.2 percent (hazard ratio, 0.98; 95 percent confidence interval, 0.69 to 1.39), and 3.7 percent (hazard ratio, 1.31; 95 percent confidence interval, 0.48 to 3.55). There was no substantial difference seen in the rates of severe or moderate bleeding by treatment assignments across estimated glomerular filtration rate categories.

“The findings suggest that renal function should be considered when deciding on the use of ticagrelor-aspirin versus clopidogrel-aspirin,” the authors write.

Salubris Pharmaceuticals contributed ticagrelor, clopidogrel, and placebo for the study at no cost and with no restrictions.

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