Prevalence of Inadequate Platelet Inhibition by Clopidogrel in Patients Receiving Hemodialysis

Alexopoulos, Dimitrios; Xanthopoulou, Ioanna; Panagiotou, Agelliki; Komninakis, Dimitrios; Germanos, Nikolaos; Goudas, Pavlos C.; Koutroulia, Eleni; Fourtounas, Costas

doi:10.1053/j.ajkd.2011.10.045

Cited by 18 publications

(15 citation statements)

References 11 publications

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“…This implies that this population may be resistant to the antiplatelet effects of clopidogrel. Indeed, a strikingly high incidence of clopidogrel resistance has been described in IRF patients, especially those with end stage renal disease undergoing hemodialysis [11]. Ticagrelor, on the other hand, seems to be much more effective in platelet inhibition in this population [12].…”

Section: Discussionmentioning

confidence: 99%

Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Davlouros

Xanthopoulou²,

Goudevenos³

et al. 2017

Cardiology

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Objectives: To assess the clinical impact of impaired renal function (IRF), in “real-world” acute coronary syndrome (ACS) patients, receiving clopidogrel, prasugrel, or ticagrelor. Methods: This was a prospective, observational, multicenter, cohort study of ACS patients undergoing percutaneous coronary interventions (PCI) with IRF (creatinine clearance <60 mL/min by Cockroft-Gault equation), who were recruited into the Greek Antiplatelet Registry (GRAPE). Patients were followed-up until 1 year for major adverse cardiovascular events (MACE; a composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and BARC (Bleeding Academic Research Consortium) bleeding. Results: Out of 2,047 registered patients, there were 344 (16.8%) with IRF. At the 1-year follow-up, MACE occurred in 18.6 and 6.2% of those patients with and without IRF, respectively: adjusted hazard ratio (HR) = 2.13 (95% confidence interval, CI 1.16-3.91), p = 0.02. IRF patients were also at higher risk of death and BARC type ≥2 and ≥3 bleeding: adjusted HR = 3.55 (95% CI 1.73-7.27), p = 0.001; HR = 2.75 (95% CI 1.13-6.68), p = 0.03; and HR = 6.02 (95% CI 2.30-15.77), p < 0.001, respectively. Combined MACE and BARC type ≥2 bleeding occurred in 34.0 and 14.0% of those with and without IRF, respectively: adjusted HR = 2.65 (95% CI 1.36-5.16), p = 0.004. At discharge, clopidogrel was more frequently prescribed in IRF patients (61.0 vs. 33.1%, p < 0.001). Conclusions: Real-world ACS patients with IRF subjected to PCI demonstrate higher thrombotic and bleeding risks than patients with normal renal function.

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Section: Discussionmentioning

confidence: 99%

Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Davlouros

Xanthopoulou²,

Goudevenos³

et al. 2017

Cardiology

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“…Chronic kidney disease has been associated with a low platelet inhibitory response to clopidogrel in both diabetic and non-diabetic patients, while HTPR is extremely common in patients on hemodialysis. [28][29][30] In addition, the presence of low platelet response to clopidogrel has been linked to worse outcome after PCI. 31 No significant effect of chronic kidney disease on clopidogrel response, either acutely (following 600 mg) or after 1 month with 150 mg clopidogrel was found in patients with chronic kidney disease and non-STEMI undergoing PCI.…”

Section: Discussionmentioning

confidence: 99%

Predictors of High On-Treatment Platelet Reactivity Early After Clopidogrel Loading in ST-Elevation Myocardial Infarction

Alexopoulos¹,

Xanthopoulou²,

Tsigkas³

et al. 2012

Circ J

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“…Five studies have shown a high incidence of HTPR on 75 mg of clopidogrel using the VerifyNow assay in HD patients: 63.6%, 82.4%, 83%, 85.7%, and 84% . These are among the highest HTPR values reported for any patient population.…”

Section: P2y12 Inhibitors In Hd Patientsmentioning

confidence: 97%

“…These are among the highest HTPR values reported for any patient population. Another study of 85 HD patients identified three factors associated with an increased risk of HTPR . One was the concomitant use of omeprazole (RR: 1.23, 95% CI: 1.01–1.57, p = 0.04).…”

Section: P2y12 Inhibitors In Hd Patientsmentioning

confidence: 99%

Oral P2Y₁₂ Receptor Inhibitors in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions: Current Knowledge and Future Directions

Jain

Reilly

2016

Seminars in Dialysis

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Oral P2Y12 receptor inhibitors are commonly used drugs in patients on hemodialysis (HD) to treat acute coronary syndrome with or without percutaneous coronary intervention (PCI), and patients with stable coronary artery disease after PCI. Clopidogrel is the most commonly prescribed P2Y12 receptor inhibitor because it is effective in the general population and is not as costly as newer FDA-approved agents (prasugrel, ticagrelor). However, increasing evidence is accumulating that clopidogrel may not be as effective in reducing mortality and preventing future ischemic events in patients with kidney disease. In this review, we will explore some of the studies that form the basis for this statement and discuss potential pharmacokinetic and pharmacodynamic reasons why clopidogrel might be less effective in HD patients, as well as explore potential risks and benefits of alternatives to clopidogrel therapy.

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Prevalence of Inadequate Platelet Inhibition by Clopidogrel in Patients Receiving Hemodialysis

Cited by 18 publications

References 11 publications

Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Predictors of High On-Treatment Platelet Reactivity Early After Clopidogrel Loading in ST-Elevation Myocardial Infarction

Oral P2Y₁₂ Receptor Inhibitors in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions: Current Knowledge and Future Directions

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Prevalence of Inadequate Platelet Inhibition by Clopidogrel in Patients Receiving Hemodialysis

Cited by 18 publications

References 11 publications

Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Predictors of High On-Treatment Platelet Reactivity Early After Clopidogrel Loading in ST-Elevation Myocardial Infarction

Oral P2Y12 Receptor Inhibitors in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions: Current Knowledge and Future Directions

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Product

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Oral P2Y₁₂ Receptor Inhibitors in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions: Current Knowledge and Future Directions