Abstract 14237: Effect of CYP2C19 Genotype on Inhibition of Platelet Aggregation in Hemodialysis Patients With Coronary Artery Disease

Background: Since hemodialysis patients have shown a relatively higher incidence of clinical events associated with thrombus, management of antiplatelet therapy after stenting would be important. The aim of this study was to evaluate platelet aggregation according to antiplatelet therapy (Prasugrel and Clopidogrel) after stenting. Methods: A total of 33 hemodialysis patients were randomized to either Prasugrel (N=16) or Clopidogrel (N=17) and evaluated with platelet aggregation (P2Y12 reaction units: PRU) with VerifyNow P2Y12 assay and CYP2C19 genotypes after stenting. Results: Patients who had a relatively high risk for bleeding, including history of stroke, were cross-overs from the Prasugrel to the Clopidogrel group (N=5). Finally, 11 patients were assigned to Prasugrel and 22 patients were assigned to Clopidogrel group. PRU level (198.9±47.8 vs. 230.6±52.6, p=0.119) and frequency of CYP2C19 genotype were not different between the Prasugrel and Clopidogrel groups. Incidence of high on-treatment platelet reactivity defied as PRU>208 tended to be lower in Prasugrel compared with Clopidogrel group (27.3 vs. 59.1%, p=0.085). According to genotype analysis, patients were classified as Responder (extensive metabolizer) and Non-responder (intermediate or poor metabolizer). PRU in Responder was similar between the 2 treatment groups (p>0.999), but Non-responder showed a significantly lower PRU in the Prasugrel compared with Clopidogrel (p=0.049). Conclusion: This study suggested that prasugrel seemed to be effective in hemodialysis patients, regardless of CYP2C19 genotypes.