Impact of Chronic Kidney Disease on Platelet Function Profiles in Diabetes Mellitus Patients With Coronary Artery Disease Taking Dual Antiplatelet Therapy

被引：199

作者：

Angiolillo, Dominick J. ^{[1
]}

Bernardo, Esther ^{[2
]}

Capodanno, Davide ^{[1
]}

Vivas, David ^{[2
]}

Sabate, Manel ^{[2
]}

Ferreiro, Jose Luis ^{[1
]}

Ueno, Masafumi ^{[1
]}

Jimenez-Quevedo, Pilar ^{[2
]}

Alfonso, Fernando ^{[2
]}

Bass, Theodore A. ^{[1
]}

Macaya, Carlos ^{[2
]}

Fernandez-Ortiz, Antonio ^{[2
]}

机构：

[1] Univ Florida, Coll Med, Jacksonville, FL 32209 USA

[2] San Carlos Univ Hosp, Cardiovasc Inst, Madrid, Spain

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2010年 / 55卷 / 11期

关键词：

clopidogrel; chronic kidney disease; diabetes mellitus; platelets; GLYCOPROTEIN-IIB-IIIA; STENT THROMBOSIS; RENAL-INSUFFICIENCY; RISK-FACTORS; INDIVIDUAL RESPONSIVENESS; CARDIOVASCULAR OUTCOMES; UREMIC PATIENTS; ELUTING STENTS; LOW-RESPONDERS; CLOPIDOGREL;

D O I：

10.1016/j.jacc.2009.10.043

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives We sought to assess the impact of renal function on platelet reactivity in patients with diabetes mellitus (DM) and coronary artery disease on aspirin and clopidogrel therapy. Background Diabetes mellitus is a key risk factor for chronic kidney disease (CKD). In aspirin-treated DM patients the presence of moderate/severe CKD is associated with reduced clinical efficacy of adjunctive clopidogrel therapy. Whether these findings may be attributed to differences in clopidogrel-induced effects is unknown. Methods This was a cross-sectional observational study in which DM patients taking maintenance aspirin and clopidogrel therapy were studied. Patients were categorized into 2 groups according to the presence or absence of moderate/severe CKD. Platelet aggregation after adenosine diphosphate (ADP) and collagen stimuli were assessed with light transmittance aggregometry and defined patients with high post-treatment platelet reactivity (HPPR). Markers of platelet activation, including glycoprotein IIb/IIIa activation and P-selectin expression, were also determined using flow cytometry. Results A total of 306 DM patients were analyzed. Patients with moderate/severe CKD (n = 84) had significantly higher ADP-induced (60 +/- 13% vs. 52 +/- 15%, p = 0.001) and collagen-induced (49 +/- 20% vs. 41 +/- 20%, p = 0.004) platelet aggregation compared with those without (n = 222). After adjustment for potential confounders, patients with moderate/severe CKD were more likely to have HPPR after ADP (adjusted odds ratio: 3.8, 95% confidence interval: 1.7 to 8.5, p = 0.001) and collagen (adjusted odds ratio: 2.4; 95% confidence interval: 1.1 to 5.4; p = 0.029) stimuli. Markers of platelet activation were significantly increased in patients with HPPR. Conclusions In DM patients with coronary artery disease taking maintenance aspirin and clopidogrel therapy, impaired renal function is associated with reduced clopidogrel-induced antiplatelet effects and a greater prevalence of HPPR. (J Am Coll Cardiol 2010;55:1139-46) (C) 2010 by the American College of Cardiology Foundation

引用

页码：1139 / 1146

页数：8

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