title: Effects of clopidogrel on mortality, cardiovascular and bleeding outcomes in patients with chronic kidney disease - data from Taiwan acute coronary syndrome full spectrum registry.
abstract: BACKGROUND
  The efficacy of clopidogrel is inconclusive in the chronic kidney disease (CKD) population with acute coronary syndrome (ACS). Furthermore, CKD patients are prone to bleeding with antiplatelet therapy. We investigated the efficacy and safety of clopidogrel in patients with ACS and CKD.
  
  
  METHODS
  In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m(2). The primary endpoints are the combined outcomes of death, non-fatal myocardial infarction and stroke at 12 months.
  
  
  RESULTS
  Overall 949 (33.7%) patients had CKD and 2660 (94.36%) patients received clopidogrel treatment. CKD is associated with increased risk of the primary endpoint at 12 months (HR 2.39, 95% CI 1.82 to 3.15, p<0.01). Clopidogrel use is associated with reduced risk of the primary endpoint at 12 months (HR 0.42, 95% CI: 0.29-0.60, p<0.01). Cox regression analysis showed that clopidogrel reduced death and primary endpoints for CKD population (HR 0.35, 95% CI: 0.21-0.61 and HR 0.48, 95% CI: 0.30-0.77, respectively, both p<0.01). Patients with clopidogrel(-)/CKD(-), clopidogrel(+)/CKD(+) and clopidogrel(-)/CKD(+) have 2.4, 3.0 and 10.4 fold risk to have primary endpoints compared with those receiving clopidogrel treatment without CKD (all p<0.01). Clopidogrel treatment was not associated with increased in-hospital Thrombolysis In Myocardial Infarction (TIMI) bleeding in CKD population.
  
  
  CONCLUSIONS
  Clopidogrel could decrease mortality and improve cardiovascular outcomes without increasing risk of bleeding in ACS patients with CKD.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.forename: Wen-Ter
authors.initials: WT
authors.lastname: Lai
authors.forename: Ho-Tsung
authors.initials: HT
authors.lastname: Hsin
authors.forename: Ai-Hsien
authors.initials: AH
authors.lastname: Li
authors.forename: Chun-Li
authors.initials: CL
authors.lastname: Wang
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Kuo
authors.forename: Juey-Jen
authors.initials: JJ
authors.lastname: Hwang
authors.forename: Fu-Tien
authors.initials: FT
authors.lastname: Chiang
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D000077144:Clopidogrel; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000401:mortality; D013624:Taiwan; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine