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Follow-up of aspirin-resistant patients with end-stage kidney disease

  • Nephrology - Original Paper
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Abstract

Background

Aspirin resistance is defined by platelet function testing and presumed clinical unresponsiveness to aspirin. Aspirin-resistant patients are at a greater risk of clinically important adverse cardiovascular events. We aimed to investigate whether end-stage renal disease patients with aspirin resistance are at increased risk for long-term major adverse clinical events.

Methods

We prospectively enrolled 78 end-stage renal disease patients between January 2008 and November 2008. The effect of aspirin on platelet functions was determined using a new generation impedance aggregometer (Multiplate analyser, Dynabyte Medical, Munich). The primary end-point was the composite of death, myocardial infarction, unstable angina, or cerebrovascular accident. Mean follow-up was 20.7 ± 6.1 months.

Results

Of the patients studied, 34 (43.58 %) were aspirin resistant and 44 (56.42 %) were not aspirin resistant. Among patients who were aspirin resistant, 13 of 34 (38.2 %) experienced death, MI, or CVA, compared to 7 of 44 (15.9 %) patients who were not aspirin resistant (p = 0.034). Multivariate analyses identified aspirin resistance to be independently associated with major adverse long-term outcomes ([HR] 2.722; 95 % CI, 1.068–6.942; p = 0.04).

Conclusion

This study demonstrates that end-stage kidney disease patients resistant to aspirin are at a greater risk of long-term major adverse events than patients who are sensitive to aspirin.

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References

  1. Antithrombotic Trialists’ Collaboration (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373:1849–1860

    Article  Google Scholar 

  2. Gasparyan AY, Watson T, Lip GY (2008) The role of aspirin in cardiovascular prevention: implications of aspirin resistance. J Am Coll Cardiol 51:1829–1843

    Article  PubMed  CAS  Google Scholar 

  3. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266

    Article  Google Scholar 

  4. Luke RG (1998) Chronic renal failure-a vasculopathic state. N Engl J Med 339:841–843

    Article  PubMed  CAS  Google Scholar 

  5. Krasopoulos G, Brister SJ, Beattie WS, Buchanan MR (2008) Aspirin “resistance” and risk of cardiovascular morbidity: systematic review and meta-analysis. BMJ 336:195–198

    Article  PubMed  Google Scholar 

  6. Tóth O, Calatzis A, Penz S, Losonczy H, Siess W (2006) Multiple electrode aggregometry: a new device to measure platelet aggregation in whole blood. Thromb Haemost 96:781–788

    PubMed  Google Scholar 

  7. Sibbing D, Braun S, Jawansky S, Vogt W, Mehilli J, Schömig A, Kastrati A, von Beckerath N (2008) Assessment of ADP-induced platelet aggregation with light transmission aggregometry and multiple electrode platelet aggregometry before and after clopidogrel treatment. Thromb Haemost 99:121–126

    PubMed  CAS  Google Scholar 

  8. von Pape KW, Dzijan-Horn M, Bohner J, Spannagl M, Weisser H, Calatzis A (2007) Control of aspirin effect in chronic cardiovascular patients using two whole blood platelet function assays. PFA-100 and Multiplate. Hamostaseologie 27:155–160

    Google Scholar 

  9. Jámbor C, Weber CF, Gerhardt K, Dietrich W, Spannagl M, Heindl B, Zwissler B (2009) Whole blood multiple electrode aggregometry is a reliable point-of-care test of aspirin-induced platelet dysfunction. Anesth Analg 109:25–31

    Article  PubMed  Google Scholar 

  10. Chamorro A, Blanc R, Ascaso C, Saiz A, Vila N (1997) Factors associated to aspirin failure for secondary stroke prevention. Med Clin (Barc) 109:569–572

    CAS  Google Scholar 

  11. Buchanan MR, Brister SJ (1995) Individual variation in the effects of ASA on platelet function: implications for the use of ASA clinically. Can J Cardiol 11:221–227

    PubMed  CAS  Google Scholar 

  12. Cipollone F, Patrignani P, Greco A, Panara MR, Padovano R, Cuccurullo F, Patrono C, Rebuzzi AG, Liuzzo G, Quaranta G, Maseri A (1997) Differential suppression of thromboxane biosynthesis by indobufen and aspirin in patients with unstable angina. Circulation 96:1109–1116

    Article  PubMed  CAS  Google Scholar 

  13. Grotemeyer KH, Scharafinski HW, Husstedt IW (1993) Two-year follow-up of aspirin responder and aspirin non responder. A pilot-study including 180 post-stroke patients. Thromb Res 71:397–403

    Article  PubMed  CAS  Google Scholar 

  14. Fateh-Moghadam S, Plöckinger U, Cabeza N, Htun P, Reuter T, Ersel S, Gawaz M, Dietz R, Bocksch W (2005) Prevalence of aspirin resistance in patients with type 2 diabetes. Acta Diabetol 42:99–103

    Article  PubMed  CAS  Google Scholar 

  15. Gum PA, Kottke-Marchant K, Welsh PA, White J, Topol EJ (2003) A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol 41:961–965

    Article  PubMed  CAS  Google Scholar 

  16. Roth GJ, Majerus PW (1975) The mechanism of the effect of aspirin on human platelets. I. Acetylation of a particulate fraction protein. J Clin Invest 56:624–632

    Article  PubMed  CAS  Google Scholar 

  17. Kawasaki T, Ozeki Y, Igawa T, Kambayashi J (2000) Increased platelet sensitivity to collagen in individuals resistant to low-dose aspirin. Stroke 31:591–595

    Article  PubMed  CAS  Google Scholar 

  18. Cambria-Kiely JA, Gandhi PJ (2002) Aspirin resistance and genetic polymorphisms. J Thromb Thrombolysis 14:51–58

    Article  PubMed  CAS  Google Scholar 

  19. Cambria-Kiely JA, Gandhi PJ (2002) Possible mechanisms of aspirin resistance. J Thromb Thrombolysis 13:49–56

    Article  PubMed  CAS  Google Scholar 

  20. Bloom A, Greaves M, Preston FE, Brown CB (1986) Evidence against a platelet cyclooxygenase defect in uraemic subjects on chronic haemodialysis. Br J Haematol 62:143–149

    Article  PubMed  CAS  Google Scholar 

  21. Cavarape A, Bauer J, Bartoli E, Endlich K, Parekh N (2003) Effects of angiotensin II, arginine vasopressin and tromboxane A2 in renal vascular bed: role of rho-kinase. Nephrol Dial Transplant 18:1764–1769

    Article  PubMed  CAS  Google Scholar 

  22. Geara AS, Azzi N, Bassil C, El-Sayegh S (2010) Aspirin resistance in hemodialysis patients. Int Urol Nephrol. doi:10.1007/s11255-010-9811

    Google Scholar 

  23. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK (2001) Clopidogrel in effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 345:494–502

    Article  PubMed  CAS  Google Scholar 

  24. Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, Topol EJ, CREDO Investigators (2002) Clopidogrel for the reduction of events during observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288:2411–2420

    Article  PubMed  CAS  Google Scholar 

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There is no relationship with industry and financial associations that might pose a conflict of interest.

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Correspondence to Kadriye Orta Kilickesmez.

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Kilickesmez, K.O., Kocas, C., Abaci, O. et al. Follow-up of aspirin-resistant patients with end-stage kidney disease. Int Urol Nephrol 45, 1097–1102 (2013). https://doi.org/10.1007/s11255-012-0217-x

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