@article { , title = {Ticagrelor-Aspirin versus Clopidogrel-Aspirin among CYP2C19 Loss-of-Function Carriers with Minor Stroke or TIA in Relation to Renal Function: A Post Hoc Analysis of CHANCE-2 Trial}, abstract = {Background: Evidence on the risk-benefit ratio of dual antiplatelet therapies among stroke patients with impaired renal function is limited and inconsistent. Objective: To investigate the effect of renal function on the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin treatment. Design: Post hoc analysis of a multicenter, randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov: NCT04078737). Setting: 202 centers in China. Patients: CYP2C19 loss-of-function allele carriers with minor stroke or transient ischemic attack. Intervention: Ticagrelor-aspirin and clopidogrel-aspirin. Measurements: Renal function was evaluated by estimated glomerular filtration rate (eGFR) levels. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days, respectively. Results: Among 6,378 patients, 4,050 (63.5\%) patients had normal (eGFR≥90 mL/min/1.73m2), 2,010 (31.5\%) patients had mildly decreased (eGFR 60-89 mL/min/1.73m2), and 318 (5.0\%) patients had moderately to severely decreased (eGFR<60 mL/min/1.73m2) renal function. The corresponding differences in recurrent stroke between ticagrelor-aspirin and clopidogrel-aspirin for normal, mildly decreased and moderately to severely decreased renal function was -2.8 percentage point (95\% CI, -4.4 to -1.3 percentage point) (hazard ratio [HR], 0.63 [CI, 0.49 to 0.81]), -0.2 percentage point (CI, -2.4 to 2.0 percentage point) (HR, 0.98 [CI, 0.69 to 1.39]), and 3.7 percentage point (CI, -2.3 to 10.1 percentage point) (HR, 1.31 [CI, 0.48 to 3.55]) respectively. Rates of severe or moderate bleeding did not substantially differ by treatment assignments across eGFR categories. Limitation: Renal function was only evaluated by using eGFR and the proportion of patients with severely decreased renal function was low. Conclusion: Patients with normal, rather than impaired renal function, received greater benefit from ticagrelor-aspirin versus clopidogrel-aspirin.}, doi = {10.7326/M22-1667}, eissn = {1539-3704}, issn = {0003-4819}, issue = {11}, journal = {Annals of Internal Medicine}, pages = {1534-1542}, publicationstatus = {Published}, url = {https://nottingham-repository.worktribe.com/output/11466600}, volume = {175}, keyword = {Alleles, Antiplatelet therapy, Estimated glomerular filtration rate, Hemorrhage, Ischemic stroke, Myocardial infarction, Renal analysis, Safety, Stroke, Transient ischemic attacks}, year = {2022}, author = {Wang, Anxin and Wang, Yongjun and Xie, Xuewei and Tian, Xue and Claiborne Johnston, S. and Li, Hao and Bath, Philip M. and Zuo, Yingting and Jing, Jing and Lin, Jinxi and Wang, Yilong and Zhao, Xingquan and Li, Zixiao and Jiang, Yong and Liu, Liping and Meng, Xia and Wang, Yongjun} }