Ticagrelor/Prasugrel as good as clopidogrel in Lowering 1-Year Mortality in STEMI Patients with Severe CKD: Study
A recent study published in BMC Nephrology evaluated the comparative effectiveness of ticagrelor/prasugrel versus clopidogrel in acute coronary syndrome (ACS) patients with chronic kidney disease (CKD). Researchers analyzed outcomes including rehospitalization, bleeding events, and mortality over 30 days and one year, with a focus on patients presenting with ST-elevation myocardial infarction (STEMI) and severely reduced kidney function (glomerular filtration rate [GFR] less than 30 ml/min).
Findings showed that during the initial 30-day period, there were no significant differences between the two groups in rates of rehospitalization, bleeding complications, or mortality, suggesting similar short-term safety profiles. However, for STEMI patients with severe CKD, ticagrelor/prasugrel use was associated with significantly lower 1-year mortality compared to clopidogrel, without an increase in bleeding risk.
This indicates a potential long-term survival benefit of the newer antiplatelet agents in this high-risk subgroup. The study highlights the importance of tailoring antiplatelet therapy in ACS patients with advanced CKD, who are often underrepresented in clinical trials. While clopidogrel remains a standard choice due to familiarity and safety concerns, ticagrelor and prasugrel may offer enhanced protection against fatal cardiovascular events in patients with severely impaired kidney function.
Researchers call for further large-scale, randomized controlled trials to confirm these observational findings and to optimize treatment guidelines for this vulnerable population.
Nimrod, P., David, M., Louay, T. et al. Optimal antiplatelet therapy in patients with acute coronary syndrome and chronic kidney disease: for the Jerusalem platelets thrombosis and intervention in cardiology (JUPITER-11) study group. BMC Nephrol 26, 429 (2025). https://doi.org/10.1186/s12882-025-04227-8
