Original title: Impact of hemodialysis on local vessel healing and thrombus formation after drug-eluting stent implantation. Reference: Akihide Konishi, et al. Journal of Cardiology 2014;64:25-31
Even though the benefit of DES implantation to the general population is undeniable, it has been proved lower in hemodialysis patients (HD); the reason behind this phenomenon remains unclear.
121 patients received angioplasty with DES implantation, 25 were in hemodialysis. Patients underwent 8-month follow-up coronary angiography with optical coherence tomography (OCT). After propensity matching, the risk of thrombus formation was 6 times higher in HD patients. Events rate was also higher in this group (mean 426 days).
OCT analysis showed no differences in neointimal thickness, neointimal area, strut coverage or apposition. In-stent thrombus formation was significantly higher in HD patients (61% vs. 19%; p=0.004). Clopidogrel was less effective after hemodialysis, but not aspirin.
Conclusion
HD is a potential risk factor in the presence of in stent thrombosis after DES implantation. Systemic alterations such as the diminished efficacy of clopidogrel and vessel characteristics after HD may contribute to a higher incidence of thrombus attachment leading to events after DES implantation.
Editorial Comment
This study shows higher asymmetry and higher in-stent thrombus attachment incidence in HD patients, as well as reduced antiplatelet effect of clopidogrel after HD. This increases post procedural events risk and calls for improved stents and post HD antiplatelet administration, either clopidogrel or a new one.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Foundation
Buenos Aires – Argentina
Carlos Fava