The efficacy and safety of short- and long-term dual antiplatelet therapy in patients with mild or moderate chronic kidney disease

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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, authors sought to determine the efficacy and safety of long-term Clopidogrel therapy in patients with CKD.
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<p>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 (&gt;90 [normal, n = 999], 60-89 [mild CKD, n = 672], &lt;60 mL/min [moderate CKD, n = 331]). </p>
<p>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 &lt; .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). </p>
<p>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. </p>
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<p><strong>Source: <br />American Heart Journal , Volume 155, Issue 4, April 2008, Pages 687-693</strong></p>