Safety and Efficacy of Prasugrel and Ticagrelor in Acute Coronary Syndrome. Results of a “Real World” Multicenter Registry

Chronic Kidney Disease and Third‐Generation P2Y12 Inhibitors Use in Patients With Acute Coronary Syndrome: Impact on the Prognosis at 1 Year

“…Nevertheless, non-CKD patients are younger, with fewer cardiovascular risk factors and other comorbidities. Similar results have been observed previously, 22,25 and in such terms it is not surprising that third-generation P2Y 12 inhibitors were more effective and even safer than clopidogrel. Although differences in third-generation P2Y 12 inhibitor use could be observed, since prasugrel is also commonly used in younger patients with lower risk of bleeding or comorbidities compared with ticagrelor, clinical outcomes associated with prasugrel are noninferior to those with ticagrelor.…”

“…Although some real‐world analyses have shown an association with higher bleeding risk, this observation is not consistent in all registries . Indeed, the last data coming from Spain showed no differences after matching‐cohort analysis . In the light of these results, it might be suggested that there is no such increase in bleeding risk when third‐generation P2Y 12 inhibitors are used, particularly in CKD patients.…”

“…For example, in a Spanish-based registry of the use of ticagrelor and prasugrel, only 2.6% of the patients receiving these antiplatelets had CKD (defined as estimated glomerular filtration rate <60 mL/min/1.73 m 2 ). 22 The low inclusion rate (10% to 15%) of CKD patients in randomized clinical trials generated a limited data set for each antiplatelet agent, which might be responsible for the low prescription rate among this population, mainly due to unknown safety outcomes. 23,24 In this real-world contemporary registry, the majority of annual event rates and event risks, even severe bleeding, were reduced in non-CKD patients receiving third-generation P2Y 12 inhibitors.…”

“…[30][31][32] Indeed, the last data coming from Spain showed no differences after matching-cohort analysis. 22 In the light of these results, it might be suggested that there is no such increase in bleeding risk when third-generation P2Y 12 inhibitors are used, particularly in CKD patients. Thus, our results reinforce data coming from the pivotal randomized clinical trials and encourage their use not only among non-CKD patients but also in CKD patients.…”

“…Moreover, the use of third‐generation P2Y 12 inhibitors among the CKD population decreases considerably. For example, in a Spanish‐based registry of the use of ticagrelor and prasugrel, only 2.6% of the patients receiving these antiplatelets had CKD (defined as estimated glomerular filtration rate <60 mL/min/1.73 m 2 ) . The low inclusion rate (10% to 15%) of CKD patients in randomized clinical trials generated a limited data set for each antiplatelet agent, which might be responsible for the low prescription rate among this population, mainly due to unknown safety outcomes …”