Clopidogrel-mediated P2Y12 inhibition according to renal function in patients with diabetes mellitus and coronary artery disease

This was a prospective ex vivo and in vitro pharmacodynamic (PD)/pharmacokinetic (PK) investigation conducted in DM patients with (n=31) and without CKD (n=30). PD assessments included platelet reactivity index, maximum platelet aggregation (MPA), and P2Y12 reaction units. Ex vivo PK assessments included plasma levels of clopidogrel and its active metabolite (C-AM). In vitro PD assessments were conducted on baseline samples incubated with escalating concentrations of C-AM. Among patients with DM treated with clopidogrel, impaired renal function was associated with increased MPA. This finding could be attributed partially to upregulation of the P2Y12 activity without differences in drug absorption or metabolism.