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首页> 外文期刊>The American heart journal >The efficacy and safety of short- and long-term dual antiplatelet therapy in patients with mild or moderate chronic kidney disease: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial.
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The efficacy and safety of short- and long-term dual antiplatelet therapy in patients with mild or moderate chronic kidney disease: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial.

机译：短期和长期双重抗血小板治疗对轻度或中度慢性肾脏病患者的疗效和安全性：氯吡格雷用于减少观察期间事件（CREDO）试验的结果。

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BACKGROUND: Mild and moderate chronic kidney disease (CKD) is associated with decreased survival and increased adverse events after a percutaneous coronary intervention (PCI). Therapy with clopidogrel decreases adverse events in large patient populations. Therefore, we sought to determine the efficacy and safety of long-term clopidogrel therapy in patients with CKD. METHODS: Two thousand two patients from the CREDO trial in whom an elective PCI of a single or multiple vessels was planned were analyzed. Patients were randomly assigned to a 300-mg loading dose of clopidogrel before PCI followed by clopidogrel 75 mg/d for a year versus a placebo loading dose at the time of the PCI procedure and clopidogrel 75 mg/d for 28 days and placebo for the remainder of a year. Patients were categorized by their estimated creatinine clearance (>90 [normal, n = 999], 60-89 [mild CKD, n = 672], <60 mL/min [moderate CKD, n = 331]). RESULTS: Diminished renal function was associated with worse outcomes. Patients with normal renal function who received 1 year of clopidogrel had a marked reduction in death, myocardial infarction, or stroke compared with those who received placebo (10.4% vs 4.4%, P < .001), whereas patients with mild and moderate CKD did not have a significant difference in outcomes with clopidogrel therapy versus placebo (mild: 12.8% vs 10.3%, P = .30; moderate: 13.1% vs 17.8%, P = .24). Clopidogrel use was associated with an increased relative risk of major or minor bleeding, but this increased risk was not different based on renal function (relative risk 1.2, 1.3, 1.1). CONCLUSIONS: Clopidogrel in mild or moderate CKD patients may not have the same beneficial effect as it does in patients with normal renal function, but was not associated with a greater relative risk of bleeding based on renal function. Further studies are needed to define the role of clopidogrel therapy in patients with CKD.
机译：背景：轻度和中度慢性肾脏疾病（CKD）与经皮冠状动脉介入治疗（PCI）后存活率降低和不良事件增加相关。氯吡格雷治疗可减少大量患者的不良事件。因此，我们试图确定长期氯吡格雷治疗CKD患者的疗效和安全性。方法：分析了来自CREDO试验的22例患者，其中计划了单个或多个血管的选择性PCI。患者在PCI前被随机分配给氯吡格雷300 mg负荷剂量，随后每年给予75 mg / d氯吡格雷，而PCI手术时为安慰剂负荷剂量，对氯吡格雷75 mg / d持续28天，而安慰剂则为PCI一年的剩余时间。根据患者估计的肌酐清除率对患者进行分类（> 90 [正常，n = 999]，60-89 [轻度CKD，n = 672]，<60 mL / min [中度CKD，n = 331]）。结果：肾功能减退与预后差有关。肾功能正常且接受氯吡格雷治疗1年的患者与接受安慰剂的患者相比，死亡，心肌梗塞或中风的发生率显着降低（分别为10.4％和4.4％，P <.001），而轻度和中度CKD患者氯吡格雷治疗与安慰剂治疗的结果无显着差异（轻度：12.8％vs 10.3％，P = 0.30;中度：13.1％vs 17.8％，P = 0.24）。使用氯吡格雷与大出血或小出血的相对危险性增加相关，但是根据肾功能的不同，这种增加的危险性没有区别（相对危险度1.2、1.3、1.1）。结论：氯吡格雷在轻度或中度CKD患者中可能没有与正常肾功能患者相同的有益作用，但与基于肾功能的相对较高的出血风险无关。需要进一步的研究来确定氯吡格雷治疗在CKD患者中的作用。

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