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• W2043702942 abstract "Background The reasons that decreased glomerular filtration rate (GFR) might alter the clinical efficacy of clopidogrel are poorly understood. Study Design In this study, we sought to evaluate whether decreased GFR alters platelet response to clopidogrel in patients receiving a maintenance dose of clopidogrel (75 mg/d for at least 8 days). Settings & Participants 126 consecutive patients categorized by estimated GFR: stages 1-2 (>60 mL/min/1.73 m2; n = 29), stage 3a (45-59 mL/min/1.73 m2; n = 21); stage 3b (30-44 mL/min/1.73 m2; n = 26), stage 4 (15-29 mL/min/1.73 m2; n = 14), and stage 5 (<15 mL/min/1.73 m2; n = 36) were prospectively enrolled. Predictor Residual platelet reactivity, defined in the VASP (Vasodilator Stimulated Phosphoprotein) flow cytometry test as platelet reactivity index (PRI) ≥61% and in the VerifyNow turbidimetric-based assay as a value >235 PRU (adenosine diphosphate receptor reaction units) or percentage of platelet inhibition <15%. Outcomes We examined factors associated with low response to clopidogrel using logistic regression. Results A significant relationship between estimated GFR, PRI, PRU, and percentage of inhibition was found. The prevalence of residual platelet reactivity was highest in patients with GFR stage 5. PRI ≥61% occurred in 52.8% of patients with stage 5 versus 30.8% of stage 3b and 24.1% of stages 1-2 (P = 0.1). PRU >235 was found in 63.6% of patients with stage 5 versus 36.8% of stage 3b and 17.2% of stages 1-2 (P = 0.005). Inhibition <15% affected 66.7% of patients with stage 5 versus 21.1% of stage 3b and 17.2% of stages 1-2 (P < 0.001). In the multivariable model, GFR stage 5 (adjusted prevalence ratio [PR], 3.10; 95% CI, 1.23-9.43; P = 0.02), and obesity (adjusted PR, 1.92; 95% CI, 1.34-2.23; P = 0.004) were the sole predictors of residual platelet reactivity. Limitations Interference of hemodialysis with the pharmacokinetics of clopidogrel could not be excluded. Conclusion GFR stage 5 is associated with substantial impairment of platelet inhibition independently of diabetes mellitus. The reasons that decreased glomerular filtration rate (GFR) might alter the clinical efficacy of clopidogrel are poorly understood. In this study, we sought to evaluate whether decreased GFR alters platelet response to clopidogrel in patients receiving a maintenance dose of clopidogrel (75 mg/d for at least 8 days). 126 consecutive patients categorized by estimated GFR: stages 1-2 (>60 mL/min/1.73 m2; n = 29), stage 3a (45-59 mL/min/1.73 m2; n = 21); stage 3b (30-44 mL/min/1.73 m2; n = 26), stage 4 (15-29 mL/min/1.73 m2; n = 14), and stage 5 (<15 mL/min/1.73 m2; n = 36) were prospectively enrolled. Residual platelet reactivity, defined in the VASP (Vasodilator Stimulated Phosphoprotein) flow cytometry test as platelet reactivity index (PRI) ≥61% and in the VerifyNow turbidimetric-based assay as a value >235 PRU (adenosine diphosphate receptor reaction units) or percentage of platelet inhibition <15%. We examined factors associated with low response to clopidogrel using logistic regression. A significant relationship between estimated GFR, PRI, PRU, and percentage of inhibition was found. The prevalence of residual platelet reactivity was highest in patients with GFR stage 5. PRI ≥61% occurred in 52.8% of patients with stage 5 versus 30.8% of stage 3b and 24.1% of stages 1-2 (P = 0.1). PRU >235 was found in 63.6% of patients with stage 5 versus 36.8% of stage 3b and 17.2% of stages 1-2 (P = 0.005). Inhibition <15% affected 66.7% of patients with stage 5 versus 21.1% of stage 3b and 17.2% of stages 1-2 (P < 0.001). In the multivariable model, GFR stage 5 (adjusted prevalence ratio [PR], 3.10; 95% CI, 1.23-9.43; P = 0.02), and obesity (adjusted PR, 1.92; 95% CI, 1.34-2.23; P = 0.004) were the sole predictors of residual platelet reactivity. Interference of hemodialysis with the pharmacokinetics of clopidogrel could not be excluded. GFR stage 5 is associated with substantial impairment of platelet inhibition independently of diabetes mellitus." @default.
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• W2043702942 date "2012-06-01" @default.
• W2043702942 modified "2023-09-25" @default.
• W2043702942 title "Association of Estimated GFR With Platelet Inhibition in Patients Treated With Clopidogrel" @default.
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• W2043702942 doi "https://doi.org/10.1053/j.ajkd.2011.12.027" @default.
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