title: Impact of chronic kidney disease on platelet inhibition of clopidogrel and prasugrel in Japanese patients.
abstract: The impact of chronic kidney disease (CKD) on the antiplatelet effect of clopidogrel and low-dose (3.75mg) prasugrel in Japanese patients is largely unknown.
  
  
  
  A total of 53 consecutive Japanese patients with stable coronary artery disease who received aspirin and clopidogrel were enrolled, and categorized by estimated glomerular filtration rate (eGFR): CKD group (n=15, eGFR<60ml/min/1.73m2) and non-CKD group (n=38, eGFR≥60ml/min/1.73m2). Clopidogrel was switched to 3.75mg prasugrel. Platelet reactivity measurement using the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA) was performed at baseline (on clopidogrel) and day 14 (on prasugrel).
  
  
  
  The VerifyNow P2Y12 reaction units (PRU) during clopidogrel therapy was significantly higher in the CKD group than that in the non-CKD group (185.2±51.1 PRU vs. 224.3±57.0 PRU, p=0.02), whereas, the PRU with the prasugrel therapy in the CKD group and non-CKD group were not significantly different (149.9±51.1 PRU vs. 165.3±61.8 PRU, p=0.36). The PRU was significantly lower with the prasugrel therapy compared to that with the clopidogrel therapy both in the CKD group and in the non-CKD group.
  
  
  
  Antiplatelet effect of clopidogrel but not prasugrel is attenuated in patients with CKD. Prasugrel achieves a consistently lower platelet reactivity compared with clopidogrel regardless of the presence of mild to moderate CKD.
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: takeshi24@hotmail.co.jp.
authors: Takeshi
authors: T
authors: Nishi
authors: Division of Pharmacy, University Hospital, Chiba University School of Medicine, Chiba, Japan; Clinical Research Center, University Hospital, Chiba University School of Medicine, Chiba, Japan.
authors: Noritaka
authors: N
authors: Ariyoshi
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Takashi
authors: T
authors: Nakayama
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Yoshihide
authors: Y
authors: Fujimoto
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Kazumasa
authors: K
authors: Sugimoto
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Shinichi
authors: S
authors: Wakabayashi
authors: Clinical Research Center, University Hospital, Chiba University School of Medicine, Chiba, Japan.
authors: Hideki
authors: H
authors: Hanaoka
authors: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Yoshio
authors: Y
authors: Kobayashi
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D008297:Male; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: Chronic kidney disease; Clopidogrel; Platelet reactivity; Prasugrel