Key result
Patients with chronic kidney disease and acute coronary syndromes should receive standard cardiovascular treatments, but antithrombotic and antiplatelet drug doses must be carefully adjusted to avoid bleeding complications.
This state-of-the-art review emphasizes the critical need for dose adjustment of antithrombotic therapies and careful selection for invasive procedures in patients with CKD presenting with acute coronary syndromes to balance ischemic benefits and bleeding risks.
Supports dose adjustment of antithrombotics in CKD-ACS to balance risks; leaves open need for RCTs to refine recommendations.
Renal dysfunction is frequent in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Chronic kidney disease (CKD) is associated with very poor prognosis and is an independent predictor of early and late mortality and major bleeding in patients with NSTE-ACS. Patients with NSTE-ACS and CKD are still rarely treated according to guidelines. Medical registers reveal that patients with CKD are usually treated with too high doses of antithrombotics, especially anticoagulants and inhibitors of platelet glycoprotein (GP) IIb/IIIa receptors, and therefore they are more prone to bleeding. Drugs which are excreted mainly or exclusively by the kidney should be administered in a reduced dose or discontinued in patients with CKD. These drugs include enoxaparin, fondaparinux, bivalirudin, and small molecule inhibitors of GP IIb/IIIa inhibitors. In long-term treatment of patients after myocardial infarction, anti-platelet therapy, lipid-lowering therapy and β-blockers are used. Chronic kidney disease patients before qualification for coronary interventions should be carefully selected in order to avoid their use in the group of patients who could not benefit from such procedures. This paper presents schemes of non-ST and ST-segment elevation myocardial infarction treatment in CKD patients in accordance with the current recommendations of the European Society of Cardiology (ESC).
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Franczyk et al. (2013) conducted a review in Non-ST-elevation myocardial infarction and ST-elevation myocardial infarction in patients with chronic kidney disease. Guideline-directed medical and invasive therapy was evaluated. Patients with chronic kidney disease and acute coronary syndromes should receive standard cardiovascular treatments, but antithrombotic and antiplatelet drug doses must be carefully adjusted to avoid bleeding complications.
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