title: Low responsiveness to thienopyridine in hemodialysis patients.
abstract: We sought to evaluate whether thienopyridine low responsiveness, a predictor of stent thrombosis, is found in hemodialysis patients. We measured platelet aggregation at the site of implantation of drug-eluting stents in 333 patients with angina pectoris undergoing dual anti-platelet therapy. Thirty-one patients were on hemodialysis (HD group), and 302 were not (N-HD group). We used a novel whole-blood aggregometer. The aggregometer used the screen filtration method, with adenosine diphosphate as an agonist. The concentration of agonist required to induce 50% of the maximum pressure rate was calculated and indicated as the platelet aggregatory threshold index (PATI). Low responsiveness for thienopyridine was defined if the PATI levels were <4 μmol/l. PATI levels (μmol/l) were significantly lower in the HD group than in the N-HD group (6.8 ± 4.8 vs. 9.1 ± 5.4, P = 0.023), and the rate of low responsiveness for thienopyridine was significantly higher in the HD group than in the N-HD group (45.7 vs. 26.8%, P = 0.019). Non-fatal myocardial infarction and stent thrombosis occurred in three of the HD group and in nine of the N-HD group (P = 0.122). Late stent thrombosis occurred at a significantly higher rate in the HD group than in the N-HD group (P = 0.002). The rate of target lesion revascularization was significantly higher in the HD group than in the N-HD group (38 vs. 11.8%, P = 0.0001). In conclusion, low responsiveness to thienopyridine, as an indicator of platelet reactivity, is found more frequently in hemodialysis patients.
authors.affiliation: Division of Cardiology, Kumamoto Central Hospital, 1-5-1 Tainoshima, Kumamoto, 862-0965, Japan, shuoshima@e-mail.jp.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Oshima
authors.forename: Katsuo
authors.initials: K
authors.lastname: Noda
authors.forename: Hironobu
authors.initials: H
authors.lastname: Fukushima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakamura
authors.forename: Makoto
authors.initials: M
authors.lastname: Shono
authors.forename: Fumihito
authors.initials: F
authors.lastname: Kugimiya
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Higa