Review of antithrombotic agents used for acute coronary syndromes in renal patients.

Management issues in acute coronary syndromes (ACSs) with regard to patients with renal insufficiency or failure are complex. Renal patients have a greater risk for bleeding compared with those with normal renal function because of prolonged bleeding time and platelet dysfunction. Some of the drugs used have significant renal excretion, such as the glycoprotein IIb/IIIa receptor antagonists. Additionally, thrombolytics are underused, which contributes to the delay in instituting immediate treatment of acute myocardial infarction. Clinical data regarding the optimum management of ACSs in renal patients are still lacking. In this article, we review the available data on the use of antithrombotic agents, particularly in patients with renal impairment.