Key result
Antiplatelet and antithrombotic therapy in end-stage renal disease requires careful individualization due to a prothrombotic state combined with high bleeding risk and a paucity of clinical trials.
Why the study?
Does antithrombotic therapy improve cardiovascular and stroke outcomes safely in patients with end-stage renal disease?
Does antithrombotic therapy improve cardiovascular and stroke outcomes safely in patients with end-stage renal disease?
Antithrombotic therapy in ESRD requires careful individualization due to the concurrent high risks of thrombosis and bleeding, alongside a lack of robust clinical trial evidence.
Alerts clinicians to balance thrombosis-bleeding risks when using antithrombotics in ESRD; leaves open optimal regimens pending dedicated trials.
The delicate balance of risk vs. benefit of using antiplatelet and antithrombotic agents in the general population is well established. The decision to use these agents in the end stage renal disease (ESRD) population remains complex and difficult. The concomitant association of a prothombotic state with high risk of bleeding in the ESRD population requires individualization and careful clinical judgment before implementing such therapy. There remains a paucity of clinical trials and lack of substantial evidence in literature for safe and effective use of antithrombotic drugs in patients with advanced chronic kidney disease. The current review summarizes the pros and cons of using antiplatelet and antithrombotic agents in primary and secondary prevention of cardiovascular events, evaluate the risks with routine use of anticoagulation for cerebrovascular stroke prevention with nonvalvular atrial fibrillation and role of newer oral anticoagulants as alternate agents in the dialysis population.
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Chunduri et al. (2017) conducted a review in End-stage renal disease (ESRD). Antiplatelet and antithrombotic agents was evaluated. Antiplatelet and antithrombotic therapy in end-stage renal disease requires careful individualization due to a prothrombotic state combined with high bleeding risk and a paucity of clinical trials.
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