Pros and cons of antithrombotic therapy in end-stage kidney disease: a 2019 update

Area of Science:

• Nephrology
• Cardiology
• Hematology

Background:

• Dialysis patients exhibit elevated risks for both thrombosis and hemorrhage.
• Many patients requiring dialysis have cardiovascular comorbidities, necessitating antithrombotic treatment for primary or secondary prevention.
• Limited randomized controlled trials exist for antiplatelet and anticoagulant therapies in dialysis populations.

Purpose of the Study:

• To provide an expert consensus on antithrombotic therapy for dialysis patients.
• To guide physicians in making informed decisions regarding antithrombotic treatment.
• To balance atherothrombotic and cardioembolic risk reduction with minimizing bleeding events.

Main Methods:

• Review of up-to-date evidence on antithrombotic therapy in dialysis patients.
• Discussion of clinical settings and therapeutic strategies based on available data.
• Highlighting data from observational studies on antiplatelet and anticoagulant drugs, alone or in combination.

Main Results:

• Current cardiology and nephrology guidelines offer ambiguous or exclusionary recommendations for these patients.
• Observational data provides insights into the risks and benefits of antithrombotic agents.
• The optimal strategy requires careful consideration of individual patient profiles.

Conclusions:

• There is a critical need for expert consensus to address the management of antithrombotic therapy in dialysis patients.
• Therapeutic choices should aim to minimize thrombotic risk while concurrently reducing bleeding events.
• Further research is needed to clarify optimal antithrombotic strategies in specific clinical situations.