Association between renal function and platelet reactivity during aspirin therapy in elderly patients with atherosclerotic cardiovascular disease

Abstract

Background: Aspirin is the key treatment in the secondary prevention of atherosclerotic cardiovascular disease. High on-treatment platelet reactivity (HTPR) to aspirin has been reported to partially account for the enhanced risk of thrombotic events. In particular, HTPR has been described more frequently among elderly patients. The aim of this study was to identify the clinical and biological factors associated with HTPR in a real-life elderly population.Methods: In this retrospective study, elderly patients with atherosclerotic cardiovascular disease on regular aspirin treatment were enrolled. Cardiovascular risk factors, routine biological parameters, comorbidities, and concomitant medications were recorded. The upper quartile of the platelet aggregation rate, determined by light transmission aggregometry with arachidonic acid, was defined as the HTPR group.Results: A total of 304 patients were included (mean age 77 ± 8 years, 76% men). Patients in the HTPR group were older than the patients in the non-HTPR group (mean age: 79 ± 7 vs. 76 ± 8 years, p = 0.008). Patients with moderately decreased estimated glomerular filtration rate (eGFR) had a higher frequency of HTPR than patients with slightly decreased eGFR or normal eGFR (35.8%, 22.5%, 12.2%, respectively, p < 0.05). In multivariate analysis, an independent risk factor for HTPR was the eGFR (OR: 0.984, 95% CI: 0.980-0.988, p < 0.001).Conclusions: Advanced age and decreased eGFR are correlated with poor pharmacodynamic response to aspirin. Antiplatelet strategy in elderly patients with atherosclerotic cardiovascular disease should be driven by an individualized approach, especially in patients with impaired renal function.

Hormones, age, and sex affect platelet responsiveness in vitro

“…In regards to the effect of sex on platelet function, in some studies males had decreased platelet aggregation versus females while others have shown the opposite 4,43–45 . Enhanced platelet activity may occur in the elderly compared to younger individuals in relation to cardiovascular disease, and in these studies, platelet activation and aggregation were more robust in the elderly versus younger patients 46–51,46,47,52,53 . This enhanced platelet activity was hypothesized to be responsible for increased vascular and thrombotic pathology, leading to hypercoagulability and cardiovascular disease 46–51,46,47,52,53 .…”

“…4,[43][44][45] Enhanced platelet activity may occur in the elderly compared to younger individuals in relation to cardiovascular disease, and in these studies, platelet activation and aggregation were more robust in the elderly versus younger patients. [46][47][48][49][50][51]46,47,52,53 This enhanced platelet activity was hypothesized to be responsible for increased vascular and thrombotic pathology, leading to hypercoagulability and cardiovascular disease. [46][47][48][49][50][51]46,47,52,53 In addition, with increased age, there is a significant decline in platelet number; in addition, females have more platelets than males.…”

“…[46][47][48][49][50][51]46,47,52,53 This enhanced platelet activity was hypothesized to be responsible for increased vascular and thrombotic pathology, leading to hypercoagulability and cardiovascular disease. [46][47][48][49][50][51]46,47,52,53 In addition, with increased age, there is a significant decline in platelet number; in addition, females have more platelets than males. [54][55][56][57][58] To correct for these numerical differences, platelets were diluted to a standard concentration for all experiments to obviate any differences in platelet activity due to platelet number.…”