The impact of renal function on platelet reactivity and clinical outcome in patients undergoing percutaneous coronary intervention with stenting

Nicoline J. Breet; Corine de Jong; Willem Jan Bos; Jochem W. van Werkum; Heleen J. Bouman; Johannes C. Kelder; Thomas O. Bergmeijer; Felix Zijlstra; Christian M. Hackeng; Jurriën M. ten Berg

doi:10.1160/th14-04-0302

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2014; 112(06): 1174-1181
DOI: 10.1160/th14-04-0302

Platelets and Blood Cells

Schattauer GmbH

The impact of renal function on platelet reactivity and clinical outcome in patients undergoing percutaneous coronary intervention with stenting

Nicoline J. Breet

¹Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

,

Corine de Jong

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

,

Willem Jan Bos

³Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands

,

Jochem W. van Werkum

¹Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

,

Heleen J. Bouman

¹Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

,

Johannes C. Kelder

¹Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

,

Thomas O. Bergmeijer

¹Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

,

Felix Zijlstra

⁴Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands

,

Christian M. Hackeng

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

⁵Department of Clinical Chemistry, St Antonius Hospital Nieuwegein, the Netherlands

,

Jurriën M. ten Berg

¹Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands

²St Antonius Center for Platelet Function research, Nieuwegein, the Netherlands

› Institutsangaben

Abstract

Summary

Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular disease. Previous studies have suggested that patients with CKD have less therapeutic benefit of antiplatelet therapy. However, the relation between renal function and platelet reactivity is still under debate. On-treatment platelet reactivity was determined in parallel by ADP- and AA-induced light transmittance aggregometry (LTA) and the VerifyNow^® System (P2Y12 and Aspirin) in 988 patients on dual antiplatelet therapy, undergoing elective coronary stenting. Patients were divided into two groups according to the presence or absence of moderate/severe CKD (GFR<60 ml/min/1.73 m²). Furthermore, the incidence of all-cause death, non-fatal acute myocardial infarction, stent thrombosis and stroke at one-year was evaluated. Patients with CKD (n=180) had significantly higher platelet reactivity, regardless of the platelet function test used. Patients with CKD more frequently had high on-clopidogrel platelet reactivity (HCPR) and high on-aspirin platelet reactivity (HAPR) regardless of the platelet function test used. After adjustment for potential confounders, this was no longer significant. The event-rate was the highest in patients with both high on-treatment platelet reactivity (HPR) and CKD compared to those with neither high on-treatment platelet reactivity nor CKD. In conclusion, the magnitude of platelet reactivity as well as the incidence of HPR was higher in patients with CKD. However, since the incidence of HPR was similar after adjustment, a higher rate of co-morbidities in patients with CKD might be the major cause for this observation rather than CKD itself. CKD-patients with HCPR were at the highest risk of long-term cardiovascular events.

Clinical Trial Registration: www.clinicaltrials.gov: NCT00352014.

Keywords

Light transmittance aggregometry - VerifyNow - clopidogrel - chronic kidney disease - clinical outcome

Volltext

Referenzen

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