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] Trial)

Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome

“…In a substudy of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial, among patients with and without diabetic nephropathy, the HRs (95% CIs) for clopidogrel versus placebo were 0.9 (0.80-1.0) for those without diabetic nephropathy and 1.1 (0.80-1.6) for those with diabetic nephropathy. 52,53 In terms of safety, more bleeding occurred with clopidogrel than placebo overall; however, there was no significant interaction based on renal function in CURE, CREDO, or CLARITY-TIMI 28. Within the CHARISMA analysis, the frequency of severe bleeding according to the Global Utilization of Streptokinase and tPA for Occluded Arteries (GUSTO) definition among patients with diabetic nephropathy was nonsignificantly higher with clopidogrel than with placebo (2.6% versus 1.5%, P=0.075).…”

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

“…188 However, evidence from the CHARISMA (Trial to assess improvement in therapeutico by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction) study indicates that clopidogrel added to aspirin may have deleterious effects in patients with advanced nephropathy. 190 More effective P2Y 12 blockers include prasugrel and ticagrelor, which is reversible. 188 In TRITON-TIMI (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction) 38, prasugrel showed superiority over clopidogrel in post-ACS prevention of recurrent ischaemic events: however prasugrel carried a risk of increased thombosis in myocardial infarction (TIMI) major bleeding.…”

Gestion péri-opératoire des patients traités par antithrombotiques en chirurgie orale. Argumentaire

“…Une bithérapie pendant 1 mois après la pose de stent nu, hors contexte IDM, d'après les études COMMIT (Clopidogrel and metoprolol in Myocardial Infarction Trial) [62] et CLARITY (Clopidogrel as Adjunctive Reperfusion Therapy) [253], permet d'obtenir une diminution significative de -0,6 à -2,5 % du critère composite (décès cardiovasculaire/ IDM/AVC) comparativement à l'aspirine seule. Plusieurs études randomisées [8,13,76,222] ont montré l'intérêt d'une bithé-rapie pendant les 6 à 12 premiers mois qui suivent la pose de stents actifs ou d'un pontage veineux, par une diminution significative du taux de thrombose sur stent, un meilleur maintien de la perméabilité du greffon veineux, ainsi qu'une baisse de la mortalité. La durée optimale de la bithérapie reste controversée [13].…”