Abstract 12562: Prasugrel May Be Associated With All-Cause Mortality Benefit in Patients on Chronic Dialysis

Abstract

Introduction: Although prasugrel has been shown to be more effective over other P2Y12 inhibitors (P2Y12-I) in the general population, it remains unclear whether it is also superior in reducing all-cause death in patients on chronic dialysis (ESKD). Methods: This longitudinal analysis included Medicare patients with ESKD on P2Y12-I from the U.S. Renal Data System registry between 2011-2015. Patients were followed from receipt of new prescription until death or censoring. The primary outcome was all-cause death, and the secondary outcome was CV death, as ascertained from the registry. Survival analysis was performed after propensity matching. Results: Our analysis included 44,619 ESKD patients on P2Y12 inhibitors - 95% received clopidogrel (n= 42,523), 3% received prasugrel (n = 1,205), and 2% received ticagrelor (n = 891). During a median follow up of 1 year, there were 2,555 (30.7%), 1,370 (31.1%), and 404 (23.0%) deaths in the prasugrel-clopidogrel, the ticagrelor-clopidogrel, and the prasugrel-ticagrelor matched cohorts, respectively. Similarly, there were 1,266 (15.2%), 667 (15.1%) and 210 (11.9%) CV-deaths in the three cohorts respectively. Prasugrel vs. clopidogrel was associated with reduced risk for death (HR 0.80; 95% CI: 0.70, 0.90). Similar findings were noted when compared to ticagrelor (HR 0.75; 95% CI: 0.57, 0.98). Prasugrel was also associated with a borderline reduced risk for CV-death when compared with clopidogrel (HR 0.85; 95% CI: 0.72, 1.01) and ticagrelor (HR 0.80; 95% CI: 0.60, 1.07). Conclusion: Our findings suggest a benefit in reduction of all-cause death, possibly by reducing CV-death with use of prasugrel over other P2Y12-I in patients on chronic dialysis. Since these results could be limited due to residual confounding, future trials should investigate whether prasugrel is superior to other P2Y12-Is in reducing all-cause death and CV-death among patients on chronic dialysis.