Summaria Francesco, Giannico Maria B, Talarico Giovanni P, Patrizi Roberto
Department of Cardiology-Policlinico Casilino, Catheter Laboratory, Rome, Italy.
Nephrourol Mon. 2015 Jul 22;7(4):e28099. doi: 10.5812/numonthly.28099. eCollection 2015 Jul.
Coronary artery disease is highly prevalent among patients with end stage renal disease/hemodialysis (ESRD/HD) and coronary percutaneous interventions (PCI) has been increased by nearly 50% over the past decade. After PCI with stent placement, guidelines recommend dual antiplatelet therapy (DAPT), but no specifically tailored pharmacotherapy approach is outlined for this frail population, mostly excluded from large randomized clinical trials (RCTs).
We reviewed current evidences on the use of antiplatelet therapy in patients with ESRD/HD undergoing PCI, focusing on the efficacy and safety of specific agents and their indications for detailed clinical settings.
Clinical setting in HD patients is the principal determinant of the type, onset, combination and duration of the DAPT. However, irrespective clinical setting, in addition to aspirin, clopidogrel is currently the most used antiplatelet agent even if no information derived from RCTs are available in ESRD. Due to the large experience acquired in routine clinical practice, the awareness of safety is higher for clopidogrel than newer antiplatelet agents. Because of lack of data, the use of prasugrel and ticagrelor is actually not recommended. However, in case of high ischemic and acceptable bleeding risk, they may be selectively used in ESRD/HD.
This investigation might contribute to delineate the best treatment options for this high risk population.
冠状动脉疾病在终末期肾病/血液透析（ESRD/HD）患者中高度流行，在过去十年中冠状动脉经皮介入治疗（PCI）增加了近50%。在置入支架的PCI术后，指南推荐双联抗血小板治疗（DAPT），但对于这一脆弱人群没有概述具体量身定制的药物治疗方法，他们大多被排除在大型随机临床试验（RCT）之外。
我们回顾了目前关于接受PCI的ESRD/HD患者使用抗血小板治疗的证据，重点关注特定药物的疗效和安全性及其在详细临床情况中的适应证。
HD患者的临床情况是DAPT类型、开始时间、联合用药及持续时间的主要决定因素。然而，无论临床情况如何，除阿司匹林外，目前氯吡格雷是最常用的抗血小板药物，尽管在ESRD患者中没有来自RCT的信息。由于在常规临床实践中积累了大量经验，氯吡格雷的安全性认知度高于新型抗血小板药物。由于缺乏数据，目前不推荐使用普拉格雷和替格瑞洛。然而，在缺血风险高且出血风险可接受的情况下，它们可在ESRD/HD患者中选择性使用。
本研究可能有助于为这一高危人群确定最佳治疗方案。
