The efficacy and safety of ticagrelor in the treatment of acute coronary syndrome patients with severe renal disease

Guo Lijuan; Yuan Yuting; Sun Xinghe; Zhang Xian; Yang Quan; Liu Xiaohui

doi:10.3760/j.issn.1673-4777.2025.02.001

Abstract：Objective To observe the efficacy and safety of ticagrelor in the treatment of acute coronary syndrome(ACS)patients with severe renal disease.Methods A total of 115 ACS patients with severe kidney disease[estimated glomerular filtration rate＜30 ml/(min·1.73 m2)]admitted to the Department of Cardiology,Peking University International Hospital from July 2018 to March 2023 were retrospectively selected.The patients were divided into ticagrelor group(38 cases)and clopidogrel group(77 cases)according to the type of antiplatelet drugs taken by the patients.Ticagrelor group was treated with aspirin enteric-coated tablets 100 mg/time,once a day combined with ticagrelor 90 mg/time,twice a day oral antiplatelet therapy.Clopidogrel group was treated with aspirin enteric-coated tablets 100 mg/time,once a day combined with clopidogrel 75 mg/time,twice a day oral antiplatelet therapy.Patients were followed up for 1 year after discharge for major adverse cardiovascular events(MACE)and bleeding events.Results The levels of N-terminal pro-brain natriuretic peptide and left atrial anteropos-terior diameter were lower/smaller in ticagrelor group than in clopidogrel group[3 343.0(1 707.0,7 125.5)ng/L vs 11 401.0(4 818.5,31 174.0)ng/L,(41±7)mmvs(44±7)mm],and the incidence of acute myocardial infarc-tion and coronary Gensini score were higher in the clopidogrel group than in the clopidogrel group[89.5％(34/38)vs 57.1％(44/77),(74±43)vs(59±31)](all P＜0.05).There was no significant difference in the incidence of MACE between the two groups at 1 year after discharge(P＞0.05).There was no significant difference in the incidence of bleeding events between the ticagrelor group and the clopidogrel group(P=0.716).However,all four cases fatal bleeding events occurred in the clopidogrel group.Conclusion Ticagrelor-based dual antiplatelet therapy is effective and safe for ACS patients with severe renal disease.