Clopidogrel responsiveness in chronic kidney disease patients with acute coronary syndrome

Year 2014, , 34 - 40, 01.03.2014

Hale Ünal Aksu Hüseyin Aksu Ender Öner Nilgün Işıksaçan Ömer Çelik Mehmet Ertürk Ali Kemal Kalkan Muhammed Hulusi Satılmışoğlu

https://doi.org/10.5798/diclemedj.0921.2014.01.0369

Abstract

Objective: Cardiovascular diseases are the leading cause of death in patients with chronic kidney disease (CKD). There is conflicting evidence about effect of CKD on clopidogrel responsiveness. We aimed to evaluate the clopidogrel responsiveness in CKD patients with acute coronary syndrome (ACS). Methods: A total of 101 patients; 55 with moderate to severe CKD and 46 with normal renal function or mild CKD, hospitalized with ACS were included in our study. Multiplate test was used to determine clopidogrel responsiveness. Platelet aggregation results were presented as aggregation unit (AU)*min and values over 470 AU*min were accepted as clopidogrel low responders. Results: The 101 patients (mean age 64.76±8.67 years; 61 [60.4%] male) were grouped into the two study groups as follows: group 1; 55 patients with eGFR60 ml/min/1.73 m2. 35 patients (34.7%) of the study population were found to have low response to clopidogrel (16 [34.8%] patients in group 1 and 18 [33.3%] patients in group 2, p=0.879) . There was no significant difference between group 1 and 2 for Multiplate test results (414.67±281.21 vs 421.56±316.19 AU*min, p=0.909). Clopidogrel low responsiveness were independently related to Multiplate test results of aspirin responsiveness (OR=1.004, CI 1.002–1.007, p=0.001) and hemoglobin (OR=0.727, CI 0.571–0.925, p=0.010). Multiplate results were also independently related to Multiplate test results of aspirin responsiveness (β=0.402, p60 ml/min/1.73 m2.

Keywords

Acute coronary syndrome, chronic kidney disease, clopidogrel response

Clopidogrel responsiveness in chronic kidney disease patients with acute coronary syndrome

Abstract

Amaç: Kardiyovasküler hastalıklar, kronik böbrek hastalığı (KBH) olanlarda önde gelen ölüm sebebidir. KBH\' nın klopidogrel cevabı üzerine olan etkisi hakkında çelişkili kanıtlar vardır. Bu çalışmada, akut koroner sendromlu kronik böbrek hastalarında klopidogrel yanıtını değerlendirmeyi amaçladık. Yöntemler: Akut koroner sendrom ile hospitalize edilen; orta ileri KBH olan 55, normal böbrek fonksiyonu olan veya hafif KBH bulunan 46; toplamda 101 hasta çalışmaya dahil edildi. Klopidogrel yanıtını değerlendirmek için Multiplate testi kullanıldı. Trombosit agregasyon sonuçları agregasyon birimi (AU)*dak olarak verildi ve 470 AU*dak üzerindeki değerler klopidogrele düşük cevaplılar olarak kabul edildi. Bulgular: Çalışmaya dahil edilen 101 hasta (ortalama yaş 64.76±8.67, 61 [60.4%]\' i erkek) şu şekilde iki çalışma grubuna ayrıldı: grup 1; eGFH60 ml/dak/1.73 m2 olan 46 hasta. Çalışma populasyonundaki 35 hastada (34.7%) klopidogrele düşük yanıt bulundu (grup 1\'den 16 [34.8%] hasta; grup 2\'den 18 [33.3%] hasta, p=0.879). Multiplate test sonuçları açısından grup 1 ve 2 arasında anlamlı fark yoktu (414.67±281.21 vs 421.56±316.19 AU*dak, p=0.909). Klopidogrele düşük yanıt, aspirin cevabının Multiplate test sonuçları ile (odds ratio [OR]=1.004, confidence interval [CI] 1.002–1.007, p=0.001) ve hemoglobin ile (OR=0.727, CI 0.571–0.925, p=0.010) bağımsız olarak ilişkili idi. Yine Multiplate sonuçları; aspirin yanıtının Multiplate test sonuçları (β=0.402, p60 ml/dak/1.73 m2 olan hastalar arasında değişmiyor.

Keywords

Akut koroner sendrom , kronik böbrek hastalığı, klopidogrel cevabı

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