Aspirin resistance in patients with impaired renal functions

Aksu, Hale Ünal; Oner, Ender; Ertürk, Mehmet; Aksu, Hüseyin; Işıksaçan, Nilgün; Ozalp, Begum; Aktüre, Gülşah; Akbay, Ertan; Özer, Leyla; Erol, Mustafa Kemal

doi:10.5603/kp.a2013.0286

Cited by 7 publications

(11 citation statements)

References 23 publications

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“…HAPR might contribute to the increasing risk of cardiovascular complications in patients with declined renal function. 32 However, Tello–Montoliu et al failed to track the link between antiplatelet response with renal dysfunction in non-diabetic patients with CAD. 33 Our study excluded patients with severe CKD, thus minimizing the impact.…”

Section: Discussionmentioning

confidence: 99%

Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease

Zhang

Liu

McCaffrey

et al. 2017

CIA

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ObjectivesPrevious studies have illustrated the link between high on-aspirin platelet reactivity (HAPR) with increasing thrombotic risks. The aim of our study was to investigate relative risk factors of HAPR in elderly patients with coronary artery disease.MethodsElderly, hospitalized coronary artery disease patients on regular aspirin treatment were enrolled from January 2014 to September 2016. Medical records of each patient were collected, including demographic information, cardiovascular risk factors, concomitant drugs and routine biological parameters. Arachidonic acid (AA, 0.5 mg/mL) and adenosine diphosphate (ADP, 5 µmol/L) induced platelet aggregation were measured via light transmission assay (LTA) to evaluate antiplatelet responses, referred as LTA–AA and LTA–ADP.ResultsA total of 275 elderly patients were included, with mean age of 77.2±8.1 years, and males accounted for 81.8%. HAPR was defined as LTA–AA in the upper quartile of the enrolled population. HAPR patients tended to have lower renal function (P=0.052). Higher serum uric acid (SUA) level, as well as lower platelet count, hemoglobin and hematocrit were observed in HAPR patients, with a higher proportion of diuretics use (P<0.05). Multivariate analysis revealed that SUA (OR: 1.004, 95% CI: 1.000–1.007, P=0.048), platelet count (OR: 0.994, 95% CI: 0.989–1.000, P=0.045), hematocrit (OR: 0.921, 95% CI: 0.864–0.981, P=0.011) and concomitant P2Y12 receptor inhibitors use (OR: 1.965, 95% CI: 1.075–3.592, P=0.028) were correlated with HAPR. Spearman’s correlation analysis demonstrated an inverse association of LTA–AA with hematocrit (r=−0.234, P<0.001), hemoglobin (r=−0.209, P<0.001) and estimated glomerular filtration rate (r=−0.132, P=0.031).ConclusionSUA, platelet count, hematocrit and P2Y12 receptor inhibitors use were independently correlated with HAPR. These parameters might provide novel therapeutic targets for optimizing antiplatelet therapy.

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Section: Discussionmentioning

confidence: 99%

Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease

Zhang

Liu

McCaffrey

et al. 2017

CIA

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“…Additionally, recent studies showed increased resistance to APT (aspirin and clopidogrel) in patients with kidney impairment compared with patients without CKD [ 8 , 9 , 10 ]. Therefore, the protective effect of APT may be reduced in patients with CKD, particularly in those with end-stage renal disease undergoing renal replacement [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating Effectiveness and Safety in Chronic Kidney Disease with Atrial Flutter Using an Anticoagulation Strategy

Wang

Bair

2020

Medicina

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Background and objectives: Recent randomized trials of oral antithrombotic drugs with atrial flutter (AFL) excluded patients with renal impairment because of their increased risk of bleeding. To date, no relevant studies have assessed the effectiveness and safety of different antithrombotic drugs in chronic kidney disease (CKD) patients with AFL. This cohort study evaluated the effectiveness and safety of different antithrombotic drugs in CKD patients with AFL. This study also investigated the risk of cardiovascular events from antithrombotic drugs through different risk profiles of stroke stratified by the CHA2DS2-VASc score. Materials and Methods: This cohort study was performed in patients with AFL and CKD who were extracted from the National Health Insurance (NHI) Database in Taiwan. Oral antithrombotic therapy (oral anticoagulants (OAC) or antiplatelets (APT)) was administered to patients who had been diagnosed with AFL after being diagnosed with CKD between 2011 and 2015. Primary outcomes, including ischemic stroke, systemic embolism, and composite of stroke, and secondary outcomes, including major adverse cardiac events (MACEs), major bleeding, all-cause mortality, and cardiovascular-related death, were examined. Results: A total of 2468 patients were included in this study. The results showed no statistically significant differences in the risk of primary outcomes. For the secondary outcomes, there were also no statistically significant differences in the risk of MACEs and major bleeding. However, the pooled results indicated that the hazard ratio (HR) for all-cause mortality with OAC was 0.24 (95% confidence interval (CI) = 0.10–0.55) compared with combination therapy, and the HR for APT compared with OAC was 2.86 (95% CI = 1.48–5.53). Conclusions: In the studied population, OAC or APT alone were proved equally effective for stroke prophylaxis. Furthermore, OAC might reduce the all-cause mortality rate compared with APT and should be considered as the first choice of oral antithrombotic drugs in patients with AFL and CKD.

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“…9,10 Moreover, there has been little research among CKD patients with HOPR assessed by a multi -channel platelet function analyzer and the AspirinWorks® test. 7,11,12 To our knowledge, no studies on the Polish population have been conducted so far. What is more, despite several years of research, there have been no clear guidelines on whether and when platelet function should be monitored in patients taking ASA for stroke prevention.…”

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confidence: 99%

“…DISCUSSION The presence of HOPR in patients treated with ASA significantly increases the risk of adverse cardiovascular events, 6 especially in patients with CKD. 7,11 This seems particularly important in this patient population because CVD--related mortality in patients with ESRD is 15 -fold higher than in the general population. 20 who also applied this method, found increased platelet reactivity in 14.8% of patients with diabetes mellitus and in 28.7% of those with acute coronary syndrome (vs 8.4% in controls).…”

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confidence: 99%

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Prevalence of high on-treatment platelet reactivity in patients with chronic kidney disease treated with acetylsalicylic acid for stroke prevention

Horyniecki¹,

Łącka-Gaździk²,

Niewiadomska³

et al. 2018

Polish Archives of Internal Medicine

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High on-treatment platelet reactivity in chronic kidney disease 667 platelet aggregation and causing vasoconstriction. 2 Up to 60% of patients on ASA exhibit high on-treatment platelet reactivity (HOPR), 3 formerly known as "aspirin resistance." The possible causes of this phenomenon might include drug interactions, alternative platelet activation pathways, non-platelet TXA2 production, genetic polymorphisms, increased platelet turnover, INTRODUCTION Due to its antiplatelet effect, acetylsalicylic acid (ASA) has been widely used in primary and secondary prevention of cardiovascular diseases (CVDs). 1 The mechanism of action of ASA is based on irreversible inhibition of platelet cyclooxygenase 1 (COX-1) and reduction of thromboxane A2 (TXA2) synthesis, which is a strong factor stimulating

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Aspirin resistance in patients with impaired renal functions

Abstract: The AR ratio was found to be high in severe CKD patients, especially haemodialysis patients, but not in mild and moderate CKD patients. This increased AR ratio in severe CKD patients may affect the prognosis in patients who already have an increased risk for cardiovascular complications.

Cited by 7 publications

References 23 publications

Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease

Predictors of high on-aspirin platelet reactivity in elderly patients with coronary artery disease

Evaluating Effectiveness and Safety in Chronic Kidney Disease with Atrial Flutter Using an Anticoagulation Strategy

Prevalence of high on-treatment platelet reactivity in patients with chronic kidney disease treated with acetylsalicylic acid for stroke prevention

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