Abstract
Background: The presence of low platelet response to antiplatelet therapies is associated with worse clinical outcomes in coronary artery disease patients. Chronic kidney disease (CKD) has been reported associated with reduced response to antiplatelet therapies. Objective: To assess the impact of renal function on platelet activity in Japanese patients with coronary artery disease on dual-antiplatelet therapy. Methods: The subjects consisted of 198 patients with coronary artery disease who were taking aspirin and clopidogrel (75 mg/day) for more than 30 days. Patients were categorized into 3 groups according to renal function, a control group, with estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73m2 (n=118) and a moderate CKD group, with eGFR 30–60 ml/min/1.73m2 (n=65), a severe CKD group, with eGFR <30 ml/min/1.73m2 (n=15). Platelet aggregatory threshold index (PATI) was measured by platelet function test (light transmittance aggregometry) and compared among the three groups. Results; Mean eGFR was 77.2±14.2 ml/min/1.73m2 in the control group, 48.3±8.5 ml/min/1.73m2 in the moderate CKD group and 9.9±7.8 ml/min/1.73m2 in the severe CKD group. Adenosine diphosphate induced PATI was significantly lower in the moderate CKD (3.28±0.99 μM) and severe CKD (3.03±1.32 μM) than in the control group (3. 66±0. 73 μM) (p<0. 05). Conclusion: The efficacy of clopidogrel and inhibition of platelet aggregation are reduced in moderate/severe CKD patients taking maintenance dual antiplatelet therapy. For the management of coronary artery disease patients with CKD, we should take care the case of low platelet response to clopidogrel.
