Renal safety evaluation of aspirin plus edaravone in patients with ischaemic stroke: a retrospective cohort study

Abstract

Background and objectiveAspirin combined with edaravone is more effective than aspirin or edaravone alone in the treatment of ischaemic stroke. Aspirin is defined as a nephrotoxic drug while the renal safety of edaravone is controversial. We aimed to evaluate whether edaravone will increase the nephrotoxicity of aspirin in patients with ischaemic stroke.DesignA propensity score-matched retrospective cohort study.SettingA tertiary hospital in China.ParticipantsPatients with ischaemic stroke were treated with aspirin from February 2007 to May 2018.Primary and secondary outcome measuresAcute kidney injury (AKI, diagnosed by the Acute Kidney Injury Network), decreased estimated glomerular filtration rate (eGFR,>10%), gastrointestinal bleeding and in-hospital adverse outcomes (defined as dying or giving up treatment in our hospital).ResultsWe included 3061 patients, and 986 pairs were successfully matched. Of the 986 pairs of patients included, the incidence of AKI between the aspirin group and the combination group showed no significant difference (7.71% vs 6.29%, p=0.217). While the incidence of eGFR decline (24.75% vs 16.94%, p<0.001) was significantly lower in the combination group. The protective effect was significant in patients with baseline eGFR >30 mL/min/1.73 m2, especially in eGFR 60–90 mL/min/1.73 m2. In patients with different complications, the incidence of AKI showed no significant differences in patients with chronic kidney injury, hypertension, anaemia, age above 75 years, except in patients with cardiovascular disease (OR, 2.82; 95% CI 1.50 to 5.29; p<0.001). However, the incidence of gastrointestinal bleeding (1.22% vs 2.84%, p=0.011) and in-hospital adverse outcomes (3.25% vs 7.00%, p<0.001) were significantly higher in the combination group.ConclusionsOur study indicated that edaravone in patients with ischaemic stroke didn’t increase the nephrotoxicity of aspirin, and even had a protective effect on mild renal deterioration. Nevertheless, there is a need to be cautious when patients are in bad pathophysiological conditions and at high risk of bleeding.

Safety of edaravone in acute ischemic stroke: A systematic review and meta-analysis

“…33 The safety outcomes from this study were included in this systematic review. Other subsequently published studies showed that among ischemic stroke patients with baseline kidney disease, there was no significant change in glomerular filtration rate after edaravone administration, 43,44 and edaravone may be protective against acute kidney injury. 45 However, a study conducted among patients with liver injury and acute ischemic stroke showed that edaravone-related liver injury accounted for 20% of evaluated patients, and most showed increases in serum aminotransferases within 7-10 days after drug administration which resolved within 10-14 days.…”

Therapeutic effect and psychological impact of aspirin plus edaravone on patients with cerebral infarction

“…This suggested that aspirin plus edaravone could improve drug synergy, improve antiplatelet aggregation while controlling the progression of the patient’s disease, and promote the recovery of damaged nerve function. Although aspirin and edaravone both have protective effects on brain tissue, their mechanisms of action are different, and combined application could reduce brain tissue damage through different mechanisms, thereby promoting the recovery of neurological function in patients[ 22 ].…”