Key result
Ticagrelor-aspirin cuts recurrent stroke ~37% vs clopidogrel-aspirin only in patients with normal renal function.
Why the study?
Evidence on the risk-benefit ratio of dual antiplatelet therapies among patients with stroke and impaired renal function is limited and inconsistent.
Does ticagrelor-aspirin reduce recurrent stroke compared to clopidogrel-aspirin in CYP2C19 loss-of-function carriers with minor stroke or transient ischemic attack?
RCT
double-blind
randomized
Yes
Does ticagrelor-aspirin reduce recurrent stroke compared to clopidogrel-aspirin in CYP2C19 loss-of-function carriers with minor stroke or transient ischemic attack?
Hazard Ratio: 0.63 (95% CI 0.49–0.81)
Absolute Risk Reduction: 2.8%
Ticagrelor-aspirin provides greater benefit than clopidogrel-aspirin for preventing recurrent stroke in CYP2C19 loss-of-function carriers with minor stroke or TIA, but this benefit appears limited to those with normal renal function.
May favor ticagrelor-aspirin in CYP2C19 LOF carriers with normal renal function; hypothesis-generating and requires RCT confirmation before practice change.
BACKGROUND: Evidence on the risk-benefit ratio of dual antiplatelet therapies among patients with stroke and impaired renal function is limited and inconsistent. OBJECTIVE: To investigate the effect of renal function on the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin treatment. DESIGN: Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial. (ClinicalTrials.gov: NCT04078737). SETTING: 202 centers in China. PATIENTS: loss-of-function allele carriers with minor stroke or transient ischemic attack. INTERVENTION: Ticagrelor-aspirin and clopidogrel-aspirin. MEASUREMENTS: Renal function was evaluated by estimated glomerular filtration rate (eGFR) levels. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days, respectively. RESULTS: ) renal function. 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. LIMITATION: Renal function was only evaluated by using eGFR, and the proportion of patients with severely decreased renal function was low. CONCLUSION: Patients with normal, rather than impaired, renal function received greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin. PRIMARY FUNDING SOURCE: Ministry of Science and Technology of the People's Republic of China.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2022) conducted an RCT in minor stroke or transient ischemic attack. Ticagrelor-aspirin vs. Clopidogrel-aspirin was evaluated on recurrent stroke within 90 days (HR 0.63, 95% CI 0.49 to 0.81). Ticagrelor-aspirin reduced recurrent stroke compared to clopidogrel-aspirin in patients with normal renal function (HR 0.63; 95% CI 0.49-0.81), but not in those with impaired renal function.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: