title: Haemodialysis impairs clopidogrel but not aspirin responsiveness in patients with end-stage renal disease. Results of a pilot study.
abstract: Dual antiplatelet therapy (DAPT) with aspirin (ASA) and clopidogrel (Clp) is the standard treatment to reduce ischaemic coronary events, but in patients with end-stage renal disease (ESRD) the efficacy of Clp remains unclear. Patients with ESRD are at higher risk for coronary artery disease (CAD) and also their post-interventional outcome is worse compared to patients with normal renal function. Little is known about the influence of haemodialysis (HD) on ASA and Clp responsiveness. To assess the effect of HD on ASA- and Clp-responsiveness in patients with documented CAD and ESRD, 31 patients with ESRD (mean age 66.5 ± 1.8 years, 23 male) on DAPT were evaluated for their ASA and Clp responsiveness with the Verify Now System (Accumetrics Inc.) We measured the antiplatelet effect in all ESRD patients at three time points: T1: just before HD; T2: directly after HD; T3: steady state on a HD free day one week after T1. In our study at baseline 10 (32.3%) patients were ASA-low responder (ASA-LR) and 14 (45.2%) patients Clp-low responder (Clp-LR). There was a significant difference in the PRU values before (T1) and immediately after HD (T2) [PRU T1=234 (169; 274) vs PRUT2= 247 (199; 278); pT1,2=0.036; ]. Results were shown as median ARU T1 (25th, 75th percentile) or median PRU T1 (25th, 75th percentile). Hence HD seems to impair responsiveness to Clp, resulting in an increase of 6.5 % Clp-LR. No significant differences in the ARU values at the different time-points were found.
authors: Patrik
authors: P
authors: Htun
authors: Tatiana
authors: T
authors: Kan
authors: Eda
authors: E
authors: Mueller
authors: Cosima
authors: C
authors: Pohle
authors: Ralf
authors: R
authors: Schindler
authors: Tobias
authors: T
authors: Geisler
authors: Meinrad
authors: M
authors: Gawaz
authors: Wolfgang
authors: W
authors: Bocksch
authors: Suzanne Fateh-Moghadam, Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum der Eberhard-Karls-Universität Tübingen, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany, Tel.: +49 7071 29809040, Fax: +49 7071 295413, E-mail: suzanne.fateh-moghadam@med.uni-tuebingen.de.
authors: Suzanne
authors: S
authors: Fateh-Moghadam
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011446:Prospective Studies; D058925:Receptors, Purinergic P2Y12 / Q000378:metabolism; D006435:Renal Dialysis / Q000009:adverse effects*; D012306:Risk; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Aspirin low responder; antiplatelet therapy; clopidogrel low responder; end stage renal disease; haemodialysis