Related Experiment Video
Updated: Nov 10, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease
Sigrid E Sandner1, Heribert Schunkert2, Adnan Kastrati2
1Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Insights
For patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery, ticagrelor increased major adverse cardiac and cerebrovascular events (MACCE) compared to aspirin. Bleeding rates were similar between the two antiplatelet therapies.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft (CABG) surgery is not well-established.
- CKD is associated with increased risks of adverse cardiovascular and bleeding events post-CABG.
Purpose of the Study:
- To evaluate the efficacy and safety of ticagrelor compared to aspirin in patients with and without CKD undergoing CABG surgery.
- To determine the impact of CKD on the outcomes of antiplatelet therapy after CABG.
Main Methods:
- A post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial.
- Compared ticagrelor versus aspirin in patients with and without CKD.
- Primary endpoint: major adverse cardiac and cerebrovascular events (MACCE) at 1 year. Secondary endpoints included individual MACCE components, all-cause death, and major bleeding.
Main Results:
- Patients with CKD had higher rates of MACCE (13% vs 8.3%) and major bleeding (5.6% vs 3.1%) at 1 year compared to those without CKD.
- In patients with CKD, ticagrelor was associated with a higher 1-year rate of MACCE (18.2% vs 8.9%) compared to aspirin.
- No significant difference in major bleeding rates was observed between ticagrelor and aspirin in patients with or without CKD.
Conclusions:
- Ticagrelor therapy in patients with CKD undergoing CABG surgery was associated with an increased incidence of MACCE compared to aspirin.
- Antiplatelet therapy choice in CKD patients undergoing CABG requires careful consideration due to potential increased risks.
Background:
The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown.
Methods:
This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding.
Results:
Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P = .01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P = .04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P = .03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P = .79; Pinteraction = .067). There was no difference in the 1-year rate of major bleeding with ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI, 0.52 to 3.97; P = .48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95% CI, 0.64 to 2.01; P = .65).
Conclusions:
Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:28Chronic Kidney Disease III: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management