Impact of Chronic Kidney Disease on Platelet Reactivity and Outcomes of Patients Receiving Clopidogrel and Undergoing Percutaneous Coronary Intervention

Mangiacapra, Fabio; Cavallari, Ilaria; Barbato, Emanuele; Ricottini, Elisabetta; Patti, Giuseppe; Vizzi, Vincenzo; D’Ambrosio, Andrea; Bruyne, Bernard De; Wijns, William; Sciascio, Germano Di

doi:10.1016/j.amjcard.2013.12.018

Cited by 32 publications

(35 citation statements)

References 30 publications

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“…A potential explanation for an abnormal response to ADP antagonist therapy in patients with CKD is an increased expression of multiple signaling pathways, higher levels of C-reactive protein, von Willenbrand factor and soluble Pselectin resulting in platelet hyper reactivity 26,27 . Conversely, there is also some evidence that GFR decline may not be associated with HTPR 28 .…”

Section: Discussionmentioning

confidence: 99%

Dipstick proteinuria is an independent predictor of high on treatment platelet reactivity in patients on clopidogrel, but not aspirin, admitted for major adverse cardiovascular events

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Dipstick proteinuria is an independent predictor of high on treatment platelet reactivity in patients on clopidogrel, but not aspirin, admitted for major adverse cardiovascular events

et al. 2014

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“…9 However, to date pharmacodynamic studies have shown discordant results on the independent role of CKD as a determinant of impaired response to clopidogrel. [11][12][13][14] Indeed, the limited sample size of these studies, composed of heterogeneous patient cohorts, may have contributed to these observations.…”

Section: See Article By Baber Et Almentioning

confidence: 89%

“…In particular, although studies have shown that, in patients with type 2 DM, impaired renal function is associated with reduced clopidogrel-induced antiplatelet effects and higher rates of HPR, 11,13 other studies performed in patients without DM have yielded inconsistent results. [12][13][14] Therefore, the higher levels of platelet reactivity shown among patients with DM and CKD may be because of a synergistic effect of the 2 pathophysiological pathways, which may explain the enhanced risk of cardiovascular events when DM and CKD coexist.…”

Section: See Article By Baber Et Almentioning

confidence: 99%

Defining the Link Between Chronic Kidney Disease, High Platelet Reactivity, and Clinical Outcomes in Clopidogrel-Treated Patients Undergoing Percutaneous Coronary Intervention

Franchi

Rollini

Angiolillo

2015

Circ: Cardiovascular Interventions

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“…Although several earlier reports have examined the association between renal impairment and platelet reactivity after PCI, results thus far have been inconsistent as previous studies were limited by modest sample sizes, inclusion of select cohorts, or lack of adequate multivariable adjustment. 14,16,17,24 In stable diabetic patients, for example, Angiolillo et al 24 previously demonstrated an independent association between CKD and HPR. Similarly, in a separate cohort involving 316 post-PCI patients with and without DM, Gremmel et al 16 also demonstrated a significant association between CKD and HPR using different assays.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 Although CKD modulates platelet function, existing studies evaluating associations between CKD and HPR have been limited by modest sample sizes, lack of adequate multivariable adjustment, and limited follow-up. [12][13][14][15][16][17] Moreover, and perhaps more clinically relevant, whether HPR exerts a similar or differential impact on both ischemic and bleeding events among those with and without CKD after PCI is unknown. Accordingly, we sought to examine the cross-sectional and longitudinal associations among CKD, HPR, and clinical events in a contemporary cohort of patients undergoing PCI with DES.…”

mentioning

confidence: 99%

Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease

Baber

Mehran

Kirtane

et al. 2015

Circ: Cardiovascular Interventions

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A dverse cardiovascular events, including cardiac death and stent thrombosis, are markedly increased among those with versus without chronic kidney disease (CKD) after percutaneous coronary intervention (PCI).1-3 Residual atherothrombotic risk remains excessive among such patients even when treated with contemporary pharmacotherapy or novel stent platforms, including second-generation drug-eluting stents (DES). 4,5 Despite the strong epidemiological links between renal impairment and thrombotic risk, underlying causal and mechanistic insights have not been fully elucidated.High platelet reactivity (HPR) to adenosine diphosphate during clopidogrel therapy has also emerged as a strong and Background-Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. Methods and Results-We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With DrugEluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P<0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. Conclusions-HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.(Circ Cardiovasc Interv. 2015;8:e001683.

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Impact of Chronic Kidney Disease on Platelet Reactivity and Outcomes of Patients Receiving Clopidogrel and Undergoing Percutaneous Coronary Intervention

Cited by 32 publications

References 30 publications

Dipstick proteinuria is an independent predictor of high on treatment platelet reactivity in patients on clopidogrel, but not aspirin, admitted for major adverse cardiovascular events

Dipstick proteinuria is an independent predictor of high on treatment platelet reactivity in patients on clopidogrel, but not aspirin, admitted for major adverse cardiovascular events

Defining the Link Between Chronic Kidney Disease, High Platelet Reactivity, and Clinical Outcomes in Clopidogrel-Treated Patients Undergoing Percutaneous Coronary Intervention

Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease

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