By Thomas S. May
TORONTO -- June 6, 2008 -- Patients should not be required to stop taking the antiplatelet agent clopidogrel before kidney transplantation, according to the results of a study presented here at the 2008 American Transplant Congress (ATC).
An increasing number of patients with kidney failure are now on clopidogrel and, currently, several transplant centres do not put these patients on the kidney transplant waiting list until they are off the drug. Therefore, patients have to decide whether they continue taking clopidogrel and remain on dialysis or stop taking it while waiting for a kidney transplant and increase their risk of thrombosis.
To determine the safety of continuing to take clopidogrel in kidney transplant recipients, William Bry, MD, California Pacific Medical Center, San Francisco, California, and colleagues conducted a retrospective study that compared patients undergoing transplantation while on clopidogrel and patients transplanted without anticoagulation.
The study findings were presented in a poster session on June 2.
Living-donor recipients who had been taking clopidogrel prior to the transplantation procedure and patients on warfarin were excluded from the analysis. Patients receiving acetylsalicylic acid (ASA) were included.
The researchers enrolled 25 patients who received clopidogrel up to the time of transplantation and 50 control subjects not on clopidogrel who underwent transplantation immediately before or after a clopidogrel-treated recipient.
The investigators found that 40% of patients in the clopidogrel group and 14% of patients in the control group needed blood transfusions (P = .01). Seven (58.3%) of 12 patients who were on both ASA and clopidogrel required blood transfusions, while 3 (23%) of 13 patients on clopidogrel alone needed blood transfusions (P = .07).
Patient and graft survival at 3-months post-transplantation was 100% in both groups.
According to the investigators, these results indicate that clopidogrel use should not be a contraindication to kidney transplantation. They noted, however, that, although kidney transplantation appears to be safe in patients receiving clopidogrel, they are at an increased risk of requiring transfusion of blood and/or blood products. Moreover, patients on both clopidogrel and ASA appear to be at an even greater risk of requiring transfusion.
[Presentation title: Kidney Transplantation on Plavix: Feasible or Foolhardy? Abstract 1272]
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