Indobufen

Patients with diabetes mellitus (DM) are particularly susceptible to contrast-associated acute kidney injury (CA-AKI). However, few studies have evaluated CA-AKI stages in patients with DM following elective percutaneous coronary intervention (PCI) with iodixanol.

Patients with DM who underwent elective PCI in 8 Chinese hospitals from May 2020 to November 2021 were prospectively enrolled in the Iodixanol-Acute Kidney Injury Registry (No. ChiCTR1800016719). According to the European Society of Urogenital Radiation on their CA-AKI diagnosis, and follow-up of major adverse renal and cardiovascular events (MARCE), CA-AKI and prognosis predictors were identified using logistic and Cox multivariable regression, respectively.

There were 1120 patients with DM included and the incidence of CA-AKI was 5.8 % (65/1120). However, most CA-AKI patients were at acute kidney injury stage 1 (96.9 %, 63/65). The dose of iodixanol was not an independent risk factor for CA-AKI, however, a hemoglobin level <110 g/L, a left ventricular ejection fraction (LVEF) <40 %, an estimated glomerular filtration rate <60 mL/min/1.73m², an N-terminal pro-B-type natriuretic peptide level ≥300 pg/mL, and the use of loop diuretics were independent risk factors. Only 3.5 % (39/1120) of patients experienced MARCE. Hypertension, LVEF <40 %, hemoglobin level <110 g/L, and age >75 years old were independent risk factors for MARCE, while in comparison to indobufen, aspirin is an independent protective factor against MARCE in diabetic patients.

The incidence of CA-AKI in patients with DM who underwent PCI was low, mostly associated with mild renal impairment, and therefore did not increase the risk of MARCE.

Currently, there is a paucity of optimal treatment methods for ischemic stroke. This study conducted a meta-analysis of the application value of indobufen combined with clopidogrel in the field of ischemic stroke.

The randomized controlled trials of indobufen combined with/without clopidogrel for the treatment of ischemic stroke were retrieved in Cochrane Library, PubMed, and CNKI from the establishment time of database to November 28, 2023. Cochrane risk-of-bias tool and Review Manager software were used for study quality evaluation and meta-analysis, respectively.

A total of 5 studies were ultimately included, published from 2021 to 2023, with a total of 408 patients. The meta-analysis results showed that the intervention group had a higher effective rate in treating stroke than the control group, with statistically significant difference (94.25% vs 75.29%, relative risk = 1.25, 95% confidence interval [CI] [1.14, 1.37], P < 0.00001), and there was no significant heterogeneity among the studies (P = 0.64, I2 = 0%). In addition, the meta-analysis results indicated that indobufen combined with clopidogrel decreased National Institutes of Health Stroke Scale score (mean difference [MD] = −3.52, 95% CI [−5.7, −1.35], P = 0.001), fibrinogen (MD = −0.65, 95% CI [−1.1, −0.2], P = 0.004), platelet aggregation (MD = −5.84, 95% CI [−6.96, −4.73], P < 0.00001), whole blood low shear viscosity (MD = −4.38, 95% CI [−4.81, −3.94], P < 0.00001), and whole blood high shear viscosity (MD = −0.96, 95% CI [−1.19, −0.73], P < 0.00001) and elevated thrombin time (MD = 0.42, 95% CI [0.09, 0.74], P = 0.01), but had no statistical effects on activated partial thromboplastin time and adverse reactions.

The dual antiplatelet therapy regimen using indobufen and clopidogrel is suitable for the treatment of ischemic stroke, which can effectively alleviate neurological damage and inhibit cerebral thrombogenesis.