Abstract 14540: Hemodialysis Impairs Clopidogrel but Not Aspirin Responsiveness in Patients With End-Stage Renal Disease
Background: Patients with end stage renal disease (ESRD) are at increased risk of adverse outcome after percutaneous coronary intervention and have a greater incidence of stent thrombosis. Little is known of the influence of hemodialysis on aspirin and clopidogrel responsiveness. Aim of the study : The aim of this study was to assess the effect of hemodialysis on aspirin- and clopidogrel response in patients (pts) with documented coronary artery disease (CAD) and end-stage renal disease (ESDR).
Methods: In 31 CAD pts with ESRD on dual antiplatelet therapy with 100 mg ASA and 75 mg Clp the response to ASA and Clp was evaluated by the Verify Now System (Accumetrics Inc.,San Diego, California). A threshold of 585 Aspirin-Reaction Units (ARU) marking the 75 th percentile of the whole population, has been defined to segregate ASA-R from ASA-LR and a cut-off value of P2Y12-reaction units (PRU) 274 (=75 th percentile) to separate Clp-R from Clp-LR. We measured the antiplatelet effect in all ESRD patients three times. (T1 : just before hemodialysis ; T2: directly after hemodialysis; T3:steady state (hemodialysis free day), one week after T1.
Results: were shown as median ARU (25th;75th percentile) or median PRU (25th;75th percentile).
Results: We included 31 ESRD pts (mean age 66.4 ± 1.7 years, 23 male, 17 (54.8%) diabetics). In our study group at baseline 7 (22.6 %) pts were ASA-LR [median ARU T1 (25th;75th percentile) = 650 (591;652)] and 8 (25.8%) pts Clp-LR [median PRUT1(25th;75th percentile) = 283 (277;331)]. There was a significant difference in the PRU values before (T1) and after hemodialysis (T2) [PRUT1=234 (169;274) vs PRU T2 =247 (199;278); pT1,2=0.036; ] Hence hemodialysis impairs responsiveness to clopidogrel, resulting in an increase of 6.5% Clp-LR. No significant differences in the ARU values at the different timepoints were found . Pts were dialysed either with polysulfone or polyamid membranes, but only the latter showed impaired Clp responsiveness after hemodialysis, converting 3 Clp-R in Clp-LR, hence increasing the Clp-LR about 13.7 %.
Conclusions: Our preliminary results show that hemodialysis, especially with polyamid membranes influences clopidogrel but not aspirin responsiveness in pts with ESRD.
- © 2010 by American Heart Association, Inc.