Clinical outcomes of patients with diabetic nephropathy randomized to clopidogrel plus aspirin versus aspirin alone (A post hoc analysis of the clopidogrel for high atherothrombotic risk and ischemic stabilization, management, and avoidance [CHARISMA] Tri

Dasgupta, Arijit, Steinhubl, Steven R., Bhatt, Deepak L., Berger, Peter B., Shao, Mingyuan, Mak, Koon-Hou, Fox, Keith A. A., Montalescot, Gilles, Weber, Michael A., Haffner, Steven M., Dimas, Alexios P., Steg, P. Gabriel, Topol, Eric J., CHARISMA Investigators and Walker, Philip J. (2009) Clinical outcomes of patients with diabetic nephropathy randomized to clopidogrel plus aspirin versus aspirin alone (A post hoc analysis of the clopidogrel for high atherothrombotic risk and ischemic stabilization, management, and avoidance [CHARISMA] Tri. American Journal of Cardiology, 103 10: 1359-1363. doi:10.1016/j.amjcard.2009.01.342


Author Dasgupta, Arijit
Steinhubl, Steven R.
Bhatt, Deepak L.
Berger, Peter B.
Shao, Mingyuan
Mak, Koon-Hou
Fox, Keith A. A.
Montalescot, Gilles
Weber, Michael A.
Haffner, Steven M.
Dimas, Alexios P.
Steg, P. Gabriel
Topol, Eric J.
CHARISMA Investigators
Walker, Philip J.
Title Clinical outcomes of patients with diabetic nephropathy randomized to clopidogrel plus aspirin versus aspirin alone (A post hoc analysis of the clopidogrel for high atherothrombotic risk and ischemic stabilization, management, and avoidance [CHARISMA] Tri
Journal name American Journal of Cardiology   Check publisher's open access policy
ISSN 0002-9149
1879-1913
Publication date 2009-05-15
Sub-type Article (original research)
DOI 10.1016/j.amjcard.2009.01.342
Volume 103
Issue 10
Start page 1359
End page 1363
Total pages 5
Place of publication Bridgewater, NJ, U.S.A.
Publisher Excerpta Medica
Language eng
Abstract No prospective randomized trial has specifically examined the long-term outcomes of clopidogrel use in patients with chronic kidney disease. This study aimed to determine the risks and benefits of long-term clopidogrel administration in patients with diabetic nephropathy, the most common form of chronic kidney disease. We performed a post hoc analysis of the CHARISMA trial, which randomly assigned patients without active acute coronary syndrome, but with established atherosclerotic disease (symptomatic) or multiple risk factors for atherosclerotic disease (asymptomatic), to clopidogrel plus aspirin versus placebo plus aspirin. All CHARISMA patients (n = 15,603) were separated into the 3 groups: nondiabetic patients, diabetic patients without nephropathy, and diabetic patients with nephropathy. Within each group, outcomes of patients randomly assigned to clopidogrel were compared with those of patients randomly assigned to placebo. Outcomes in the prespecified CHARISMA subgroups of asymptomatic and symptomatic patients were also compared with respect to study drug assignment and nephropathy status. Patients with nephropathy who received clopidogrel had no difference in bleeding, but experienced significantly increased cardiovascular (CV) and overall mortality compared with those randomly assigned to placebo. There were no differences in bleeding, overall mortality, or CV mortality for nondiabetic or diabetic patients without nephropathy who received clopidogrel versus placebo. In the asymptomatic cohort, patients with nephropathy randomly assigned to clopidogrel had significantly increased overall and CV mortality compared with placebo, whereas asymptomatic patients without nephropathy randomly assigned to clopidogrel had no significant mortality difference compared with placebo. In conclusion, this post hoc analysis suggested that clopidogrel may be harmful in patients with diabetic nephropathy. Additional studies are needed to investigate this possible interaction.
Keyword Coronary-artery-disease
Antiplatelet therapy
Renal-function
Events
Pharmacokinetics
Cytochrome-P450
Hemodialysis
Inhibition
Failure
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Philip J. Walker is a member of the CHARISMA Investigators. Article published in section: Coronary Artery Disease.

Document type: Journal Article
Sub-type: Article (original research)
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