published in this issue of the Journal of Nephrology [] highlights with a solid sample size the role of antiplatelet therapy on patency of dialysis vascular access (78% AV fistulae)
13, Patients with end-stage renal disease (ESRD) on maintenance dialysis have an increased risk of ischaemic events, such as recurrent myocardial infarction (MI) and stroke
2 Thrombotic events frequently lead to percutaneous coronary interventions and dual antiplatelet therapy with aspirin plus an oral Li et al
Scientific reports have shown CKD to be an enhancing risk factor for the development of 15 202 patients admitted to the hospital with an ACS randomized to ticagrelor vs clopidogrel
Enoxaparin (Lovenox) 30 mg SQ q12h
Conclusions: Clopidogrel 75mg once daily was well tolerated in patients with either moderate or severe renal failure, and provided good inhibition of ADP-induced platelet aggregation without excessive extension of bleeding time
04% before dialysis and 29
Rivaroxaban use in severe CKD, particularly in patients on dialysis, is quite contentious
In this contemporary cohort of patients, results were concordant with the pooled effect from the current meta-analysis
It is controversial whether hemodialysis affects the efficacy of the antiplatelet agents
1 Survey data suggest that the prevalence of CKD in the United States has increased between 1988 to 1994 and 1999 to 2004 from 10% to 13%, reaching a rate of 14% in 2010
Pulmonary embolism (PE) is an obstruction of the pulmonary artery or its branches by a thrombus (sometimes due to fat or air)
12; and RR, 1
CrCl, mL/min Random Overall reflecting that there were no exclusion criteria for renal dysfunction in the PLATO trial except for the requirement of dialysis
Empirical dose adjustment and biological monitoring seem to be necessary along with In studies of patients without acute coronary syndrome, Plavix only slightly decreased the risk of having a heart attack when compared to no care at all or if the patient was given a placebo
Methods: We retrospectively enrolled patients who had received regular dialysis and had undergone percutaneous coronary intervention (PCI) for AMI at our hospital between January 2013 and December 2016
patients who initiated HD with a national dialysis provider received heparin during their HD session
The support for this use requires consideration of literature from many specialties and situations (trauma, OR, post-op, various anatomical locations of bleeds, etc), but DDAVP appears to help in patients on ASA (2) Methods: Studies were included comparing ticagrelor and clopidogrel in ESKD patients on chronic dialysis with ACS or CCS
Their prevalence is increasing in recent years [ 1 ], reaching the rate of 20-40% for depression [ 2, 3] and 20-52% for anxiety [ 4 ], depending on the methodological approach
Methods: We compared effectiveness and safety of clopidogrel, prasugrel, and ticagrelor in a longitudinal study using the United States Renal Data System registry Medical inpatients, long-term care residents, persons with minor injuries, and long-distance travelers are at increased risk of VTE, which can be fatal
"Patients with atrial fibrillation already face a high risk of kidney disease, perhaps because many such patients have risk factors In patients with ACS and on dialysis, the risks for MACE, all-cause death, cardiac death and major bleeding event within 12 months were higher with ticagrelor than with clopidogrel
In a study evaluating hemostasis among ESRD patients, authors found decreased thrombin generating capacity and clopidogrel like Renal transplant patients amounted to 21% of the RRT patients with MI
Yes: If Plavix (clopidogrel) is needed, for instance within a year of receiving a drug eluting stent, it can be taken during dialysis treatm
2%] in the placebo group, relative risk reduction of 18%)
Aspirin reduced vascular access failure rate and did not increase major bleeding rate
73 m 2 or dialysis) undergoing PCI, including cardiovascular death, death from any cause, MI, stroke, and bleeding events
A comprehensive search was
Patient advice: Inform patients of the increased risk of bleeding and bruising, and to report unanticipated, prolonged, or excessive bleeding, or blood in their stool/urine
It is also a type of antiplatelet medicine
Bleeding in uremia relates to an acquired defect of primary hemostasis caused by platelet dysfunction and altered platelet-vessel wall interaction ( 1 )
Recommended starting dosage is 5 mg daily in Clopidogrel is a prodrug whose bioactive form is created through enzymatic cleavage in the liver
Properly designed observational studies and randomized controlled trials are needed to establish the role of clopidogrel in patients with ESKD, the use of platelet assays to
Study Inclusion Criteria
In the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor, compared with clopidogrel, reduced the composite endpoint of cardiovascular death
37 ± 5
A double-blind randomized trial comparing the effect of ticagrelor versus clopidogrel in 48 patients with nondialysis CKD stage 4–5 showed significant
The kidney-dialysis market will be resilient even as obesity drugs gain in popularity since patients taking the appetite-suppressing therapies may live longer
Practitioners commonly use heparin to anticoagulate the dialysis circuit during hemodialysis (HD)
The primary composite efficacy outcome was a combination of all-cause and cardiovascular mortality, recurrent myocardial infarction or coronary revascularization, and
Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD)
Unlike clopidogrel, ticagrelor exhibits a more rapid onset and offset of platelet inhibition effect, even in patients receiving hemodialysis, and it is not influenced by the cytochrome P450 (CYP) 2C19 allele
Standard dose - 220mg once daily Dose reduced to 150mg once daily (or rarely 75mg once daily) in
The relevant literature was searched using the following electronic databases without any language
We considered that clopidogrel may be a better choice over ticagrelor for this population
Supplemental dose
( 1
Daily oral care and semiannual dental checkups reduce mortality in patients receiving dialysis
Essentials Uncertainty remains about antiplatelets for vascular access patency in hemodialysis patients
70 Despite similar active metabolite generation from clopidogrel, on-treatment platelet reactivity seems to be