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Evidence-based Knowledge Synthesis and Hypothesis Validation: Navigating Biomedical Knowledge Bases via Explainable AI and Agentic Systems
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A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy?

Alexandru Burlacu1,2, Bogdan Artene3,4, Adrian Covic2,5

  • 1Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania.

Cardiovascular Drugs and Therapy
|September 7, 2018
PubMed

Insights

Thrombolytic therapy (TT) is crucial for stroke, heart attack, and PE but poses risks in advanced chronic kidney disease (CKD). Current guidelines lack clarity, leading to underutilization of TT in these high-risk patients.

Area of Science:

  • Cardiology
  • Neurology
  • Nephrology

Background:

  • Thrombolytic therapy (TT) is vital for acute ischemic stroke (AIS), ST-elevation myocardial infarction (STEMI), and massive pulmonary embolism (PE).
  • Advanced chronic kidney disease (CKD) complicates the risk-benefit assessment of TT due to altered thrombotic/thrombolytic balance and increased hemorrhage risk.

Purpose of the Study:

  • To review scientific evidence on the benefits and risks of TT in patients with advanced CKD.
  • To address the lack of specific guidelines for TT use in advanced CKD.

Main Methods:

  • A PubMed search was conducted for studies on TT in STEMI, AIS, and PE patients with advanced CKD.
  • Included study types: RCTs, observational studies, reviews, meta-analyses, and guidelines.

Main Results:

  • CKD's prothrombotic state increases hemorrhage risk with TT.
  • Concerns about bleeding and poor outcomes lead to underutilization or delayed TT in advanced CKD.

Conclusions:

  • The impact of TT on advanced CKD patients is poorly understood, with limited guideline data and conflicting study results.
  • Clinicians face challenges in optimizing TT benefits for this high-risk group pending further RCT evidence.
Abstract

Keywords:
Acute ischemic strokeAcute myocardial infarctionAdvanced chronic kidney diseaseFibrinolysisPulmonary embolismThrombolysis

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