Effect of Platelet Inhibition According to Clopidogrel Dose in Patients With Chronic Kidney Disease

Platelet Reactivity in Patients With Chronic Kidney Disease Receiving Adjunctive Cilostazol Compared to a High-maintenance Dose of Clopidogrel

Impaired renal function is associated with reduced responsiveness to clopidogrel. There are no studies which have shown a means by which to overcome platelet hyporesponsiveness in patients with chronic kidney disease (CKD). The purpose of this study was to determine the functional impact of cilostazol in patients with CKD undergoing hemodialysis.

The aims of this study is to evaluate the effects of platelet responsiveness to clopidogrel or cilostazol in CKD patients undergoing hemodialysis. The differences in platelet activation markers are also evaluated before and after clopidogrel or cilostazol administration. The investigators will perform a prospective, randomized study to compare the degree of platelet inhibition and platelet activation markers by adjunctive cilostazol (100 mg twice daily) compared to clopidogrel (75 or 150 mg/day) in CKD patients undergoing hemodialysis.

Inclusion Criteria:

• CKD patients undergoing chronic hemodialysis and PCI for stable coronary artery disease

Exclusion Criteria:

• known allergies to aspirin, clopidogrel, or cilostazol thienopyridine use before enrollment
• concomitant use of other anti-thrombotic drugs (oral anticoagulants and dipyridamole)
• platelet count <100 x 106/μL
• hematocrit < 25%
• liver disease (bilirubin > 2 mg/dl)
• active bleeding or bleeding diathesis
• gastrointestinal bleeding within the last 6 months
• hemodynamic instability
• acute coronary or cerebrovascular event within 3 months
• malignancy
• concomitant use of a cytochrome P450 inhibitor or a non-steroidal anti-inflammatory drug
• recent treatment (<30 days) with a glycoprotein IIb/IIIa antagonist.