Related Experiment Video
Updated: Aug 8, 2025
A Modified Two Kidney One Clip Mouse Model of Renin Regulation in Renal Artery Stenosis
Published on: October 26, 2020
Prasugrel-Based De-Escalation in Patients With Acute Coronary Syndrome According to Renal Function
Jun Pil Yun1, Jeehoon Kang1, Kyung Woo Park1
1Seoul National University Hospital, Seoul, Republic of Korea.
Insights
Prasugrel dose de-escalation after percutaneous coronary intervention (PCI) benefits patients with coronary artery disease, irrespective of their renal function. This strategy effectively reduces bleeding risks, particularly in those with impaired kidney function.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Patients with coronary artery disease (CAD) and impaired renal function face elevated risks of bleeding and ischemic events post-percutaneous coronary intervention (PCI).
- Renal function significantly influences the management and outcomes of patients undergoing PCI.
Purpose of the Study:
- To evaluate the efficacy and safety of a prasugrel-based de-escalation strategy in patients with varying degrees of renal function.
- To determine if prasugrel de-escalation impacts bleeding and ischemic outcomes differently across renal function categories.
Main Methods:
- A post hoc analysis of the HOST-REDUCE-POLYTECH-ACS study involving 2,311 patients with available estimated glomerular filtration rate (eGFR).
- Patients were stratified into three groups based on eGFR: high (>90 mL/min), intermediate (60-90 mL/min), and low (<60 mL/min).
- Primary endpoints included bleeding outcomes (BARC type 2 or higher) and ischemic outcomes (cardiovascular death, MI, stent thrombosis, revascularization, ischemic stroke) at 1-year follow-up.
Main Results:
- Prasugrel de-escalation demonstrated benefits across all renal function groups (P interaction = 0.508).
- A higher relative reduction in bleeding risk was observed with prasugrel de-escalation in the low eGFR group (64%) compared to intermediate (50%) and high (52%) eGFR groups.
- No significant increase in ischemic risk was associated with prasugrel de-escalation across any eGFR group (P interaction = 0.119).
Conclusions:
- Prasugrel dose de-escalation is a beneficial strategy for patients with acute coronary syndrome undergoing PCI, regardless of baseline renal function.
- The de-escalation strategy significantly reduces bleeding events, with a more pronounced effect in patients with lower estimated glomerular filtration rates.
Background:
Patients with coronary artery disease and impaired renal function are at higher risk for both bleeding and ischemic adverse events after percutaneous coronary intervention (PCI).
Objectives:
This study assessed the efficacy and safety of a prasugrel-based de-escalation strategy in patients with impaired renal function.
Methods:
We conducted a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS study. Patients with available estimated glomerular filtration rate (eGFR) (n = 2,311) were categorized into 3 groups. (high eGFR: >90 mL/min; intermediate eGFR: 60 to 90 mL/min; and low eGFR: <60 mL/min). The end points were bleeding outcomes (Bleeding Academic Research Consortium type 2 or higher), ischemic outcomes (cardiovascular death, myocardial infarction, stent thrombosis, repeated revascularization, and ischemic stroke), and net adverse clinical event (including any clinical event) at 1-year follow-up.
Results:
Prasugrel de-escalation was beneficial regardless of baseline renal function (P for interaction = 0.508). The relative reduction in bleeding risk from prasugrel de-escalation was higher in the low eGFR group than in both the intermediate and high eGFR groups (relative reductions, respectively: 64% (HR: 0.36; 95% CI: 0.15-0.83) vs 50% (HR: 0.50; 95% CI: 0.28-0.90) and 52% (HR: 0.48; 95% CI: 0.21-1.13) (P for interaction = 0.646). Ischemic risk from prasgurel de-escalation was not significant in all eGFR groups (HR: 1.18 [95% CI: 0.47-2.98], HR: 0.95 [95% CI: 0.53-1.69], and HR: 0.61 [95% CI: 0.26-1.39]) (P for interaction = 0.119).
Conclusions:
In patients with acute coronary syndrome receiving PCI, prasugrel dose de-escalation was beneficial regardless of the baseline renal function.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:06Renal Drug Clearance: Overview
Renal clearance can be calculated using different methods. One approach is to divide the urinary drug excretion rate by the plasma drug concentration. This method directly measures renal clearance, indicating the kidneys' efficiency in...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:15Renal Drug Excretion: Overview
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules...
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...