Follow-up of aspirin-resistant patients with end-stage kidney disease.
BACKGROUND
Aspirin resistance is defined by platelet function testing and presumed clinical unresponsiveness to aspirin. Aspirin-resistant patients are at a greater risk of clinically important adverse cardiovascular events. We aimed to investigate whether end-stage renal disease patients with aspirin resistance are at increased risk for long-term major adverse clinical events.


METHODS
We prospectively enrolled 78 end-stage renal disease patients between January 2008 and November 2008. The effect of aspirin on platelet functions was determined using a new generation impedance aggregometer (Multiplate analyser, Dynabyte Medical, Munich). The primary end-point was the composite of death, myocardial infarction, unstable angina, or cerebrovascular accident. Mean follow-up was 20.7 ± 6.1 months.


RESULTS
Of the patients studied, 34 (43.58 %) were aspirin resistant and 44 (56.42 %) were not aspirin resistant. Among patients who were aspirin resistant, 13 of 34 (38.2 %) experienced death, MI, or CVA, compared to 7 of 44 (15.9 %) patients who were not aspirin resistant (p = 0.034). Multivariate analyses identified aspirin resistance to be independently associated with major adverse long-term outcomes ([HR] 2.722; 95 % CI, 1.068-6.942; p = 0.04).


CONCLUSIONS
This study demonstrates that end-stage kidney disease patients resistant to aspirin are at a greater risk of long-term major adverse events than patients who are sensitive to aspirin.
Department of Cardiology, Istanbul University Institute of Cardiology, Haseki, Aksaray, 34350, Istanbul, Turkey. kadriye11@yahoo.com
Kadriye Orta
KO
Kilickesmez
Cuneyt
C
Kocas
Okay
O
Abaci
Baris
B
Okcun
Bilal
B
Gorcin
Tevfik
T
Gurmen
D000368:Aged; D000789:Angina, Unstable / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D019540:Area Under Curve; D001241:Aspirin / Q000627:therapeutic use*; D002423:Cause of Death; D015331:Cohort Studies; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D010979:Platelet Function Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin