It is controversial whether hemodialysis affects the efficacy of the antiplatelet agents. We aimed to investigate the impact of hemodialysis on efficacies of the antiplatelet agents in coronary artery disease (CAD) patients complicated with end-stage renal disease (ESRD). 86 CAD patients complicated with ESRD requiring hemodialysis were consecutively enrolled. After 5-day treatment with aspirin and clopidogrel or ticagrelor, the platelet aggregations induced by arachidonic acid (PL_AA) or adenosine diphosphate (PL_ADP), and the P2Y₁₂ reaction unit (PRU) were measured before and after hemodialysis. The propensity matching score method was adopted to generate a control group with normal renal function from 2439 CAD patients. In patients taking aspirin, the PL_AA remained unchanged after hemodialysis. In patients taking clopidogrel, the PL_ADP (37.26 ± 17.04 vs. 31.77 ± 16.09, p = 0.029) and corresponding clopidogrel resistance (CR) rate (23 [48.9%] vs. 14 [29.8%], p = 0.022) significantly decreased after hemodialysis, though PRU remained unchanged. Subgroup analysis indicated that PL_ADP significantly decreased while using polysulfone membrane (36.8 ± 17.9 vs. 31.1 ± 14.5, p = 0.024). In patients taking ticagrelor, PL_ADP, and PRU remained unchanged after hemodialysis. ESRD patients had higher incidences of aspirin resistance (AR) and CR compared to those with normal renal function (AR: 16.1% vs. 0%, p = 0.001; CR: 48.4% vs. 24.8%, p = 0.024). Hemodialysis does not have negative effect on the efficacies of aspirin, clopidogrel and ticagrelor in ESRD patients with CAD. ESRD patients have higher incidences of AR and CR compared with those with normal renal function.

Trial registration ClinicalTrials.gov Identifier: NCT03330223, first registered January 4, 2018.

血液透析是否影响抗血小板药物的疗效存在争议。我们的目的是研究血液透析对冠状动脉疾病（CAD）合并终末期肾病（ESRD）患者抗血小板药物疗效的影响。连续入组86例CAD并发ESRD需要血液透析的患者。阿司匹林和氯吡格雷或替格瑞洛治疗5天后，测定血液透析前后花生四烯酸（PL _AA）或二磷酸腺苷（PL _ADP）诱导的血小板聚集以及P2Y _{12反应单位（PRU）。}采用倾向匹配评分法从2439例CAD患者中产生肾功能正常的对照组。在服用阿司匹林的患者中，血液透析后 PL _AA保持不变。在服用氯吡格雷的患者中，PL _ADP（37.26 ± 17.04 vs. 31.77 ± 16.09，p  = 0.029）和相应的氯吡格雷抵抗（CR）率（23 [48.9%] vs. 14 [29.8%]，p  = 0.022）显着下降血液透析后，尽管 PRU 保持不变。亚组分析表明，使用聚砜膜时PL _{ADP显着下降（36.8 ± 17.9 与 31.1 ± 14.5，} p  = 0.024）。在服用替格瑞洛的患者中，血液透析后 PL _ADP和 PRU 保持不变。与肾功能正常的患者相比，ESRD 患者阿司匹林抵抗 (AR) 和 CR 的发生率较高（AR：16.1% vs. 0%，p  = 0.001；CR：48.4% vs. 24.8%，p  = 0.024）。血液透析不会对阿司匹林、氯吡格雷和替格瑞洛在患有 CAD 的 ESRD 患者中的疗效产生负面影响。与肾功能正常的患者相比，ESRD 患者 AR 和 CR 的发生率较高。

试验注册ClinicalTrials.gov 标识符：NCT03330223，首次注册于 2018 年 1 月 4 日。