Haemodialysis impairs clopidogrel but not aspirin responsiveness in patients with end-stage renal disease

Patrik Htun; Tatiana Kan; Eda Mueller; Cosima Pohle; Ralf Schindler; Tobias Geisler; Meinrad Gawaz; Wolfgang Bocksch; Suzanne Fateh-Moghadam

doi:10.1160/TH13-04-0289

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 111(04): 662-669
DOI: 10.1160/TH13-04-0289

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Haemodialysis impairs clopidogrel but not aspirin responsiveness in patients with end-stage renal disease

Results of a pilot study

Authors

Patrik Htun

¹Zentralklinikum Augsburg, Zentrale Notaufnahme und Medizinische Klinik IV, Augsburg, Germany
Tatiana Kan

²Medizinische Klinik mit Schwerpunkt Kardiologie, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum, Humbold-Universität zu Berlin, Germany
Eda Mueller

²Medizinische Klinik mit Schwerpunkt Kardiologie, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum, Humbold-Universität zu Berlin, Germany
Cosima Pohle

³KfH Kuratorium für Dialyse und Nierentransplantation e.V., KfH-Nierenzentrum Berlin, Germany
Ralf Schindler

⁴Medizinische Klinik mit Schwerpunkt Nephrologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Humbold-Universität zu Berlin, Germany
Tobias Geisler

⁵Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
Meinrad Gawaz

⁵Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
Wolfgang Bocksch

⁵Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany
Suzanne Fateh-Moghadam

⁵Medizinische Klinik III, Abteilung für Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universität Tübingen, Germany

Abstract

Summary

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 PRU_T2= 247 (199; 278); p_T1,2=0.036; ]. Results were shown as median ARU T1 (25^th, 75^th 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.

Keywords

Aspirin low responder - clopidogrel low responder - end stage renal disease - haemodialysis - antiplatelet therapy

Full Text

References

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