{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T21:02:14Z","timestamp":1792270934967,"version":"4.4.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,5,21]]},"abstract":"\n Background<\/jats:title>\n \n Although recommended in the guidelines, the safety of chronic P2Y\n 12<\/jats:sub>\n inhibitor therapy in patients with chronic kidney disease (\n CKD<\/jats:styled-content>\n ) after an acute myocardial infarction (\n MI<\/jats:styled-content>\n ) is not well studied.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n The\n TRANSLATE<\/jats:styled-content>\n \u2010ACS (Treatment with ADP Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study included 11\u00a0108\n MI<\/jats:styled-content>\n patients treated with percutaneous coronary intervention and discharged alive on a P2Y\n 12<\/jats:sub>\n inhibitor from 233\n US<\/jats:styled-content>\n hospitals. We compared rates of GUSTO (Global Use of Strategies to Open Occluded Arteries) severe\/moderate bleeding and premature discontinuation of P2Y\n 12<\/jats:sub>\n inhibitor by 1\u00a0year after\n MI<\/jats:styled-content>\n among patients with varying\n CKD<\/jats:styled-content>\n severity. The majority of\n MI<\/jats:styled-content>\n patients treated with percutaneous coronary intervention had\n CKD<\/jats:styled-content>\n : 42% had stage 2 (mild), 27% had stage 3 (moderate), and 4% had stage \u22654 (severe\/end stage). Higher potency P2Y\n 12<\/jats:sub>\n inhibitors (prasugrel or ticagrelor) were prescribed at discharge in 39%, 35%, 23%, and 15% (\n P<\/jats:italic>\n <0.01) of patients with stages 1, 2, 3, and \u22654, respectively. One\u2010year\n GUSTO<\/jats:styled-content>\n severe\/moderate bleeding rates were higher with each stage of\n CKD<\/jats:styled-content>\n : 1% in patients with\n CKD<\/jats:styled-content>\n stage 1 or no\n CKD<\/jats:styled-content>\n , 2% with an adjusted hazard ratio of 1.61 (95% CI, 1.05\u20132.35) for\n CKD<\/jats:styled-content>\n stage 2, 4% with an adjusted hazard ratio of 1.92 (95% CI, 1.21\u20133.02) for\n CKD<\/jats:styled-content>\n stage 3, and 10% with an adjusted hazard ratio of 2.44 (95% CI, 1.40\u20134.23) for patients with\n CKD<\/jats:styled-content>\n stage \u22654. By 1\u00a0year after\n MI<\/jats:styled-content>\n , 16% of patients overall had prematurely discontinued P2Y\n 12<\/jats:sub>\n inhibitor therapy; however, this rate was not largely affected by\n CKD<\/jats:styled-content>\n stage. Premature P2Y\n 12<\/jats:sub>\n inhibitor\u2013discontinuation rates were higher for patients discharged on higher potency P2Y\n 12<\/jats:sub>\n inhibitors in patients with\n CKD<\/jats:styled-content>\n stage \u22652 (\n P<\/jats:italic>\n <0.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n CKD<\/jats:styled-content>\n severity was associated with a higher bleeding risk among those with acute\n MI<\/jats:styled-content>\n treated with a P2Y\n 12<\/jats:sub>\n inhibitor. Patients with more advanced\n CKD<\/jats:styled-content>\n were not significantly more likely than those with less advance CKD to prematurely discontinue P2Y\n 12<\/jats:sub>\n inhibitor therapy.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.012236","type":"journal-article","created":{"date-parts":[[2019,5,9]],"date-time":"2019-05-09T09:19:41Z","timestamp":1557393581000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Safety of Dual\u2010Antiplatelet Therapy After Myocardial Infarction Among Patients With Chronic Kidney Disease"],"prefix":"10.1161","volume":"8","author":[{"given":"Jennifer A.","family":"Rymer","sequence":"first","affiliation":[{"name":"Department of Medicine Duke University Medical Center Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Kaltenbach","sequence":"additional","affiliation":[{"name":"Division of Cardiology Duke Clinical Research Institute Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob A.","family":"Doll","sequence":"additional","affiliation":[{"name":"University of Washington Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Messenger","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Colorado School of Medicine Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Medicine Duke University Medical Center Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine Duke University Medical Center Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.865352"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-156-6-201203200-00007"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-139X.2006.00179.x"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000134"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182742c84"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.933796"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.12.012"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv531"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.17.1842"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.014992"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2011.08.021"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309023291001"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2014.11.023"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq494"},{"key":"e_1_3_1_16_2","first-page":"CD008834","article-title":"Antiplatelet agents for chronic kidney disease","volume":"2","author":"Palmer SC","year":"2013","unstructured":"Palmer SC, Di Micco L, Razavian M, Craig JC, Perkovic V, Pellegrini F, Jardine MJ, Webster AC, Zoungas S, Strippoli GF. 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J Lab Clin Med. 1986;108:246\u2013252.","journal-title":"J Lab Clin Med"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.119.012236","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:47:41Z","timestamp":1715600861000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.119.012236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,21]]},"references-count":19,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2019,5,21]]}},"alternative-id":["10.1161\/JAHA.119.012236"],"URL":"https:\/\/doi.org\/10.1161\/jaha.119.012236","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,21]]},"assertion":[{"value":"2019-01-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e012236"}}