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Antiplatelet Therapy in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions

Francesco Summaria1, Maria B Giannico1, Giovanni P Talarico1

  • 1Department of Cardiology-Policlinico Casilino, Catheter Laboratory, Rome, Italy.

Nephro-Urology Monthly
|November 4, 2015
PubMed

Insights

Dual antiplatelet therapy (DAPT) for patients with end-stage renal disease (ESRD) undergoing coronary interventions lacks specific trial data. Clopidogrel is commonly used, but newer agents may be considered selectively.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Coronary artery disease is common in end-stage renal disease (ESRD) patients on hemodialysis (HD).
  • Percutaneous coronary interventions (PCI) are increasingly performed in this population.
  • Current guidelines for dual antiplatelet therapy (DAPT) post-PCI lack specific recommendations for ESRD/HD patients.

Purpose of the Study:

  • To review current evidence on antiplatelet therapy use in ESRD/HD patients undergoing PCI.
  • To focus on the efficacy and safety of specific antiplatelet agents for this population.
  • To provide insights into tailored pharmacotherapy for high-risk ESRD/HD patients.

Main Methods:

  • Systematic review of existing literature on antiplatelet therapy in ESRD/HD patients undergoing PCI.
  • Analysis of efficacy and safety data for various antiplatelet agents.
  • Evaluation of clinical settings influencing DAPT choices.

Main Results:

  • Clinical context is key in determining DAPT type, timing, combination, and duration for HD patients.
  • Clopidogrel, alongside aspirin, is the most frequently used agent despite a lack of randomized controlled trial (RCT) data in ESRD.
  • Safety data for clopidogrel is more established than for newer agents like prasugrel and ticagrelor.
  • Prasugrel and ticagrelor are generally not recommended due to insufficient data, but may be selectively used in high-risk scenarios.

Conclusions:

  • This review aims to guide optimal antiplatelet treatment strategies for ESRD/HD patients undergoing PCI.
  • Further research is needed to establish evidence-based DAPT protocols for this vulnerable group.
Abstract

Keywords:
Antiplatelet TherapyClopidogrelDrug Eluting StentHemodialysis PatientsPercutaneous Coronary InterventionsPrasugrelTicagrelor

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