말기신부전 환자에서 항혈소판 제제가 혈소판기능에 미치는 영향

Abstract

Objective: Uremic bleeding is well recognized problem. In patients with renal failure, the safety of antiplatelet therapy is doubtful and there is little data about the platelet function in dialysis patients who are prescribed antiplatelet agents. The aim of this study is to investigate the platelet function in dialysis patients who were taking antiplatelet agents. Methods: The cross-sectional study was performed on 49 patients who have been undergoing dialysis (A group, 19 patients), normal renal function (B group, 30 patients). All of them have taken aspirin and clopidogrel. The control group (C group) consisted of 30 patients who have been undergoing dialysis, not taking aspirin or clopidogrel. The in-vitro closure time was measured using a PFA-100 device that had cartridges holding a membrane with a central aperture and this was coated with either collagen/epinephrine (CEPI) or collagen/adenosine diphosphate (CADP). In vitro closure time was measured by each cartridge defined CADP and CEPI. Results: The CADP and CEPI were higher in the patients with end stage renal disease (ESRD) and who were not taking dual blockers than the normal range (CADP: 80-162, CEPI: 64-121). CADP prolonged in A group compared to C group. Hemodialysis, platelet count < 201×106/L, hematocrit, antiplatelet medication are relevant to the prolongation of CEPI and CADP in binary logistic regression analyses. Conclusion: Platelet function in ESRD patients was deteriorated irrespective of antiplatelet medication, which became even worse if they took antiplatelet drugs. Therefore, we have to take careful attention to the increased bleeding tendency of ESRD patients due to the antiplatelet drugs.