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Shen J, Deng Y, Wang L, Zha F. Effect of ticagrelor on the function of tunneled cuffed catheter in maintenance hemodialysis patients. Ther Apher Dial 2023. [PMID: 36889934 DOI: 10.1111/1744-9987.13980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To observe the effect of ticagrelor on the function of a tunneled cuffed catheter (TCC) in maintenance hemodialysis (MHD) patients. METHODS Eighty MHD patients (control group: 39 cases, observation group: 41 cases) using TCC as vascular access were enrolled from January 2019 to October 2020 in this prospective study. Patients in the control group were routinely treated with aspirin for antiplatelet therapy, while patients in the observation group were treated with ticagrelor. The catheter life time, catheter dysfunction, coagulation function, and antiplatelet drug-related adverse events of the two groups were recorded. RESULTS The median life time of TCC in the control group was significantly higher than that in the observation group. Moreover, the log rank test showed that the difference was statistically significant (p < 0.001). CONCLUSION Ticagrelor may reduce the incidence of catheter dysfunction and prolong the life time of the catheter by preventing and reducing the thrombosis of TCC in MHD patients, without obvious side effects.
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Affiliation(s)
- Jianming Shen
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yanyan Deng
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Liping Wang
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Fei Zha
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
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Abrahams T, Brown A, Pol D. Prescribing Trends and Health Care Expenditure of P2Y12 Prescriptions in Australia Over the Last Decade. Heart Lung Circ 2022; 31:1369-1375. [DOI: 10.1016/j.hlc.2022.06.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/02/2022] [Accepted: 06/06/2022] [Indexed: 10/16/2022]
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Jain N, Martin BC, Dai J, Phadnis MA, Al-Hindi L, Shireman TI, Hedayati SS, Rasu RS, Mehta JL. Age Modifies Intracranial and Gastrointestinal Bleeding Risk from P2Y 12 Inhibitors in Patients Receiving Dialysis. KIDNEY360 2022; 3:1374-1383. [PMID: 36176642 PMCID: PMC9416835 DOI: 10.34067/kid.0002442022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/16/2022] [Indexed: 01/11/2023]
Abstract
Background Individuals aged ≥75 years are the fastest-growing population starting dialysis for end-stage kidney disease (ESKD) due to living longer with coronary artery disease. ESKD alone can increase bleeding risk, but P2Y12 inhibitor (P2Y12-I) antiplatelet medications prescribed for cardiovascular treatment can exacerbate this risk in patients with ESKD. The age-specific rates of bleeding complications in dialysis patients with ESKD on P2Y12-I remain unclear, as does how age modifies the bleeding risk from P2Y12-I use in these patients. Methods In a retrospective cohort study, we collected data on 40,972 patients receiving maintenance hemo- or peritoneal dialysis who were newly prescribed P2Y12-I therapy between 2011 and 2015 from the USRDS registry. We analyzed the effect of age on the time to first bleed and the interactions between age and P2Y12-I type on modifying the effects of a bleed. Results Twenty percent of the cohort were aged ≥75 years. There were 3096 (8%) gastrointestinal (GI) and 1298 (3%) intracranial (IC) bleeding events during a median follow-up of 1 year. Annual incidence rates for IC bleeds were 2% in those aged <55 years and 3% in those aged ≥75 years. Rates for GI bleeds were 4% in those aged <55 years and 9% in those aged ≥75 years. On clopidogrel, prasugrel, and ticagrelor, for every decade increase in age of the cohort members, the risk of IC bleed increased by 9%, 55%, and 59%, and the risk of GI bleed increased by 21%, 28%, and 39%, respectively. At age ≥75 years, prasugrel was associated with a greater risk of IC bleed than clopidogrel. At age ≥60 years, ticagrelor was associated with a greater risk of GI bleed than clopidogrel. Conclusions More potent P2Y12-Is (prasugrel and ticagrelor) were associated with a disproportionately higher risk of IC bleed with increasing age compared with that of clopidogrel-prasugrel was much worse than clopidogrel at age ≥75 years. All three drugs were associated with only modest increase in the risk of GI bleed with every decade increase in age-ticagrelor was much worse than clopidogrel at ≥60 years of age. These results highlight the need for head-to-head clinical trials for the use of P2Y12-Is in patients with ESKD to determine age cutoffs where the risk of bleeding outweighs the benefits of thrombosis prevention.
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Affiliation(s)
- Nishank Jain
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Junqiang Dai
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas
| | - Milind A. Phadnis
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas
| | - Layth Al-Hindi
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Theresa I. Shireman
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - S. Susan Hedayati
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rafia S. Rasu
- Department of Pharmacotherapy, University of North Texas Health Sciences, Fort Worth, Texas
| | - Jawahar L. Mehta
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas
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Rasu RS, Hunt SL, Dai J, Cui H, Phadnis MA, Jain N. Accurate Medication Adherence Measurement Using Administrative Data for Frequently Hospitalized Patients. Hosp Pharm 2021; 56:451-461. [PMID: 34720145 PMCID: PMC8554601 DOI: 10.1177/0018578720918550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Pharmacy administrative claims data remain an accessible and efficient source to measure medication adherence for frequently hospitalized patient populations that are systematically excluded from the landmark drug trials. Published pharmacotherapy studies use medication possession ratio (MPR) and proportion of days covered (PDC) to calculate medication adherence and usually fail to incorporate hospitalization and prescription overlap/gap from claims data. To make the cacophony of adherence measures clearer, this study created a refined hospital-adjusted algorithm to capture pharmacotherapy adherence among patients with end-stage renal disease (ESRD). Methods: The United States Renal Data System (USRDS) registry of ESRD was used to determine prescription-filling patterns of those receiving new prescriptions for oral P2Y12 inhibitors (P2Y12-I) between 2011 and 2015. P2Y12-I-naïve patients were followed until death, kidney transplantation, discontinuing medications, or loss to follow-up. After flagging/censoring key variables, the algorithm adjusted for hospital length of stay (LOS) and medication overlap. Hospital-adjusted medication adherence (HA-PDC) was calculated and compared with traditional MPR and PDC methods. Analyses were performed with SAS software. Results: Hospitalization occurred for 78% of the cohort (N = 46 514). The median LOS was 12 (interquartile range [IQR] = 2-34) days. MPR and PDC were 61% (IQR = 29%-94%) and 59% (IQR = 31%-93%), respectively. After applying adjustments for overlapping coverage days and hospital stays independently, HA-PDC adherence values changed in 41% and 52.7% of the cohort, respectively. When adjustments for overlap and hospital stay were made concurrently, HA-PDC adherence values changed in 68% of the cohort by 5.8% (HA-PDC median = 0.68, IQR = 0.31-0.93). HA-PDC declined over time (3M-6M-9M-12M). Nearly 48% of the cohort had a ≥30 days refill gap in the first 3 months, and this increased over time (P < .0001). Conclusions: Refill gaps should be investigated carefully to capture accurate pharmacotherapy adherence. HA-PDC measures increased adherence substantially when adjustments for hospital stay and medication refill overlaps are made. Furthermore, if hospitalizations were ignored for medications that are included in Medicare quality measures, such as Medicare STAR program, the apparent reduction in adherence might be associated with lower quality and health plan reimbursement.
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Affiliation(s)
- Rafia S. Rasu
- University of North Texas Health Science Center, Fort Worth, USA
| | | | - Junqiang Dai
- University of Kansas Medical Center, Kansas City, USA
| | - Huizhong Cui
- University of Kansas Medical Center, Kansas City, USA
| | | | - Nishank Jain
- University of Arkansas for Medical Sciences, Little Rock, USA
- Central Arkansas Veterans Healthcare System, Little Rock, USA
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Jain N, Phadnis MA, Hunt SL, Dai J, Shireman TI, Davis CL, Mehta JL, Rasu RS, Hedayati SS. Comparative Effectiveness and Safety of Oral P2Y12 Inhibitors in Patients on Chronic Dialysis. Kidney Int Rep 2021; 6:2381-2391. [PMID: 34514199 PMCID: PMC8418979 DOI: 10.1016/j.ekir.2021.06.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Although oral P2Y12 inhibitors (P2Y12-Is) are one of the most commonly prescribed medication classes in patients with end stage kidney disease on dialysis (ESKD), scarce data exist regarding their benefits and risks. Methods We compared effectiveness and safety of clopidogrel, prasugrel, and ticagrelor in a longitudinal study using the United States Renal Data System registry of Medicare beneficiaries with ESKD. Individuals who filled new P2Y12-I prescriptions between 2011 and 2015 were included and followed until death or censoring. The primary exposure variable was P2Y12-I assignment. The primary outcome variable was death. Secondary outcomes included cardiovascular (CV) death, coronary revascularization, and gastrointestinal (GI) hemorrhage. Survival analyses were performed after propensity matching. Results Of 44,619 patients with ESKD who received P2Y12-Is, 95% received clopidogrel (n = 42,523), 3% prasugrel (n = 1205), and 2% ticagrelor (n = 891). To balance baseline differences, propensity-matching was performed: 1:6 for prasugrel (n = 1189) versus clopidogrel (n = 7134); 1:4 for ticagrelor (n = 880) versus clopidogrel (n = 3520); and 1:1 for ticagrelor versus prasugrel (n = 880). Prasugrel was associated with a reduced risk for death versus clopidogrel and ticagrelor (adjusted hazard ratio [HR] = 0.82; 95% CI: 0.73–0.93 and 0.78; 95% CI: 0.64–0.95). Compared with clopidogrel, prasugrel reduced risk for coronary revascularization (HR = 0.91; 95% CI: 0.86–0.96). There were no differences in GI hemorrhage between P2Y12-Is. Conclusion In patients with ESKD, prasugrel compared with others reduced risk of death possibly by reducing risk for coronary revascularizations and without worsening gastrointestinal hemorrhage. Future trials are imperative to compare efficacy and safety of P2Y12-Is in patients with ESKD.
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Affiliation(s)
- Nishank Jain
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas, USA
| | - Milind A Phadnis
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Suzanne L Hunt
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Junqiang Dai
- Department of Biostatistics and Data Science, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Theresa I Shireman
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Clayton L Davis
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jawahar L Mehta
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Medicine Service, Central Arkansas Veterans Affairs Medical Center, Little Rock, Arkansas, USA
| | - Rafia S Rasu
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences, Fort Worth, Texas, USA
| | - S Susan Hedayati
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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