Impact of renal function on platelet aggregation: a comparative study of prasugrel and clopidogrel.

BACKGROUND

Chronic kidney disease is common in patients with coronary artery disease (CAD) and can significantly affect drug excretion and efficacy. This study focuses on the effects of modification of renal function on platelet aggregation.

METHODS

In total, 164 patients with stable CAD undergoing dual antiplatelet therapy were enrolled and randomised to receive either 75 mg clopidogrel or 3.75 mg prasugrel daily. Patients were stratified based on estimated glomerular filtration rate (eGFR) into two groups: eGFR <45 (eGFR <45 group) or ≥45 mL/min/1.73 m2 (eGFR ≥45 group). The primary endpoint was the inhibition of platelet aggregation on day 5 and day 30. Analysis of covariance was performed to compare the P2Y12 reaction units (PRU) on days 5 and 30 after randomisation.

RESULTS

In the eGFR <45 group, prasugrel induced a more rapid decrease in platelet aggregation than clopidogrel. Mean PRU value for clopidogrel and prasugrel at baseline, day 5 and day 30 was 198.2 vs 177.2, 214.2 vs 157.9 and 200.0 vs 141.7, respectively. The differences were statistically significant on day 5 (p=0.036), but not on day 30 (p=0.105). The p for interaction between treatment effect and eGFR was 0.498 at baseline, 0.028 at day 5 and 0.212 at day 30, emphasising that the drug effect was significantly different by kidney function, but only in the early phase of drug initiation.

CONCLUSION

In patients with impaired renal function, prasugrel provided a more rapid reduction in platelet aggregation compared with clopidogrel, particularly during the early phase of antiplatelet treatment. Further research is needed to confirm these findings in larger and more diverse populations.

TRIAL REGISTRATION NUMBER: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000027055; Unique identifier: UMIN000023489.