Abstract 172: The Effects of Renal Function on Platelet Reactivity in Patients Treated with Clopidogrel and Admitted for Major Adverse Cardiovascular Events in a Community Setting
Introduction Increased platelet reactivity (PR) while on antiplatelet therapy is associated with worse outcomes. There are conflicting results regarding the influence of renal function on PR in patients taking clopidogrel. Here we assessed the relationship between renal function, PR, and outcomes in a community practice setting.
Methods We retrospectively reviewed 98 consecutive, non-dialysis patients admitted for major adverse cardiovascular events (MACE) to our institution between 2011 and 2012 that had PR values measured with the VerifyNow P2Y12 Assay. High PR was defined as a PRU >230 and low PR as a PRU ≤178. Renal function was classified based on estimated glomerular filtration rate at the time of assay. All cause mortality, readmissions, length of stay (LOS), and number of cardiac catheterizations were reviewed over 455 days.
Results The prevalence of PRU>230 was 100% in stage 4 and 5 CKD, 42.9% in stage 3, 53.8% in stage 2, and 53.3% in stage 1 (p=0.049, figure 1). In patients presenting with acute coronary syndromes (n=49), a significant positive association existed between PRU and total number of cardiac catheterizations (p=0.014). Overall patients with PRU value >230 had longer LOS when compared to those with PRU≤230 (median of 2 days vs. 1 day, p=0.049). A positive correlation between HbA1c and PRU was also found (p=0.018). All 8 deaths had abnormal PRU (3 patients with PRU≤178, 5 patients with PRU>230).
Conclusion Advanced CKD is associated with impairment of platelet inhibition by clopidogrel measured with the VerifyNow P2Y12 Assay. Elevated PRU is associated with worse outcomes. We observed a significant correlation between HbA1c and degree of platelet inhibition.
- © 2013 by American Heart Association, Inc.