Does Hemodialysis Affect Clopidogrel Resistance as Measured by VerifyNow® P2Y12 Test?

Geara, Abdallah S.; Ayoub, Isabelle; Rached, Jacques Abi; Siddique, Muhammad N.; Ghimire, Pratima; El‐Sayegh, Suzanne

doi:10.1016/j.amjcard.2011.01.003

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…Geara et al (26) measured the antiplatelet effect by the Ver-ifyNow system before and after the haemodialysis in 21 patients with ESRD. He found significant differences in the PRU levels before and after dialysis and concluded that exposure to dialysis circuit can lead to changes in platelet reactivity, but could not provide an explanation for this observation.…”

Section: Discussionmentioning

confidence: 99%

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

Htun¹,

Kan²,

Mueller³

et al. 2014

Thromb Haemost

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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.

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Section: Discussionmentioning

confidence: 99%

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

Htun¹,

Kan²,

Mueller³

et al. 2014

Thromb Haemost

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“…The results were unchanged pre/post-HD. Contrary to these results, hemodialysis was found in one study to decrease platelet reactivity and in another study to increase platelet reactivity by the VerifyNow assay (28,29). The increase in platelet reactivity appeared to be membrane dependent (29).…”

Section: Pharmacology Of Clopidogrel In the General Population And Eskdmentioning

confidence: 63%

Clopidogrel Use in End‐Stage Kidney Disease

Tanios

Itani

Zimmerman

2014

Seminars in Dialysis

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Clopidogrel irreversibly binds to the P2Y12 platelet receptor and acts as a potent inhibitor of platelet activation and aggregation. It is currently recommended for the prevention of cardiovascular events in patients with acute coronary syndromes, recent ischemic stroke, and peripheral arterial disease. Clopidogrel is a prodrug requiring hepatic conversion into its active metabolite. In the general population, genetic polymorphisms in the CYP2C19 gene interfering with hepatic conversion and the ABCB1 gene interfering with gut absorption of clopidogrel, account for the large interindividual response to clopidogrel and clopidogrel resistance. Chronic kidney disease (CKD) and ESKD are independent risk factors for clopidogrel resistance; 50-80% of patients with ESKD have high on-treatment residual platelet reactivity when treated with clopidogrel. This may partially explain the abysmal outcomes for patients with kidney disease post coronary intervention. Several assays are used to determine residual on-treatment platelet reactivity; however, their use in tailoring the suitability of clopidogrel treatment in patients with ESKD is unclear. Although clopidogrel decreased cardiovascular events in the general population after acute coronary syndromes and percutaneous intervention in the CURE and CREDO trials, a reanalysis of these studies in patients with CKD (eGFR <60 ml/minute) showed either a reduced or no benefit from clopidogrel treatment. ESKD patients were not represented in these two large trials; this is true for most of the trials that established clopidogrel as an integral part of the therapeutic armamentarium for cardiovascular disease. Furthermore, clopidogrel has been associated with an increased risk of death, death from bleeding, and hospitalization for bleeding in patients with ESKD. In conclusion, current evidence suggests that ESKD patients may not derive the same benefits from clopidogrel therapy as the general population and this therapy may be associated with harm. Properly designed observational studies and randomized controlled trials are needed to establish the role of clopidogrel in patients with ESKD, the use of platelet assays to tailor therapy, and the role of other antiplatelet agents such as prasugrel or ticagrelor in patients who exhibit high on-treatment residual platelet reactivity.

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“…Geara et al assessed clopidogrel resistance in patients undergoing HD before and after HD sessions; they found differences in results using a VerifyNow test. 25…”

Section: Discussionmentioning

confidence: 99%

Aspirin Resistance in Patients Undergoing Hemodialysis and Effect of Hemodialysis on Aspirin Resistance

Aksu

Oner

Çelik

et al. 2013

Clin Appl Thromb Hemost

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The aim of this study was to evaluate the prevalence of aspirin resistance (AR) in patients undergoing hemodialysis (HD) and to assess the effect of HD on the results of the Multiplate test. A total of 54 patients undergoing HD were included in this study. Blood samples were taken just before and after the HD session. To determine AR, we used Multiplate test. Platelet aggregation values of the study population were 363.01 ± 225.69 aggregation unit (AU) × minutes before and 375.33 ± 254.05 AU × minutes after the HD (P = .597). There was strong correlation between the values before and after HD (R = .755, P < .0001). The AR status was changed in 9 (16.6%) patients after HD. Agreement of AR status before and after HD was substantial (κ coefficient = .667, P < .0001). The prevalence of AR in patients undergoing HD seems higher than in most of the studied populations, and this study has shown that the AR statuses of a significant number of patients undergoing HD change after an HD session.

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Does Hemodialysis Affect Clopidogrel Resistance as Measured by VerifyNow® P2Y12 Test?

Cited by 9 publications

References 7 publications

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

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

Clopidogrel Use in End‐Stage Kidney Disease

Aspirin Resistance in Patients Undergoing Hemodialysis and Effect of Hemodialysis on Aspirin Resistance

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