Background: Oral P2Y12 inhibitors including clopidogrel, prasugrel, and ticagrelor are FDA-approved for patients presenting with acute coronary syndrome. Due to systematic exclusion of patients with end stage renal disease (ESRD) on outpatient dialysis from major trials, scarce data exist to report contemporary use of these drugs in ESRD patients.
Study design: Retrospective chart review of patient records.
Setting and participants: From 2011-2015, 848 ESRD patients (32%) had prescriptions for oral P2Y12 inhibitors such as clopidogrel, prasugrel, and ticagrelor. Differences in patient characteristics as well as major adverse events (MAEs) defined as a composite of new coronary stent placement, heart valve replacement, coronary artery bypass graft or amputation; and all-cause death, nose and gastrointestinal (GI) bleeding were collected.
Results: Of the 85 patient records that were reviewed, there were 68.2% males, 66.7% whites, 21.4% African Americans and 9% on peritoneal dialysis. There were no differences in baseline characteristics of patients who were prescribed the three drugs. 18 (21.2%) deaths, 57 (67.1%) MAEs, 9 (10.6%) nose bleeds and 13 (15.3%) GI bleeds were identified over 16.5 months follow up. There was no difference in clinical outcome variables between the three groups.
Conclusion: Oral P2Y12 inhibitors were commonly prescribed to ESRD patients despite the inadequacy of data and there were no differences in the profiles of ESRD patients who were prescribed the three drugs or their outcome variables. All-cause death, MAEs, nose and GI bleeds were common in these patients. Future studies are needed to investigate clinical benefits and risks associated with use of P2Y12 inhibitors in this high-risk patient population.