Abdeldayem Tarek, Jeyalan Visvesh, Hayat Afzal, Memon Saif, Farag Mohamed, Egred Mohaned
Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne NE4 5PL, UK.
J Clin Med. 2025 Jun 3;14(11):3956. doi: 10.3390/jcm14113956.
Cardiovascular disease is the primary cause of mortality and morbidity in patients with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD) undergoing hemodialysis. This paper examines the challenges of managing acute coronary syndrome (ACS) in ESRD patients, focusing on the delicate balance between thrombotic and bleeding risks. The review explores the mechanisms underlying the increased thrombotic risk in ESRD, including elevated platelet aggregation, endothelial dysfunction, and alterations in coagulation factors. Paradoxically, ESRD patients also exhibit higher bleeding tendencies due to platelet dysfunction and other uremia-related factors. The efficacy and safety of various antiplatelet therapies, including aspirin and P2Y12 inhibitors, are evaluated in this population. While potent P2Y12 inhibitors such as ticagrelor and prasugrel have demonstrated potential in reducing ischemic events, they are associated with an increased bleeding risk. The optimal duration of anti-platelet therapy (DAPT) in ESRD patients remains controversial, with studies suggesting potential benefits of prolonged DAPT but also increased bleeding risk. This review underscores the necessity for further research and patient inclusion in clinical trials to establish evidence-based guidelines for tailoring antithrombotic therapy in this high-risk population.
心血管疾病是慢性肾脏病（CKD）患者，尤其是接受血液透析的终末期肾病（ESRD）患者死亡和发病的主要原因。本文探讨了ESRD患者急性冠状动脉综合征（ACS）管理面临的挑战，重点关注血栓形成和出血风险之间的微妙平衡。该综述探讨了ESRD患者血栓形成风险增加的潜在机制，包括血小板聚集增加、内皮功能障碍和凝血因子改变。矛盾的是，由于血小板功能障碍和其他与尿毒症相关的因素，ESRD患者也表现出更高的出血倾向。本文评估了包括阿司匹林和P2Y12抑制剂在内的各种抗血小板治疗的疗效和安全性。虽然替格瑞洛和普拉格雷等强效P2Y12抑制剂在降低缺血事件方面已显示出潜力，但它们与出血风险增加有关。ESRD患者抗血小板治疗（DAPT）的最佳持续时间仍存在争议，研究表明延长DAPT可能有益，但出血风险也会增加。该综述强调了进一步研究以及将患者纳入临床试验的必要性，以便为这一高危人群制定基于证据的抗栓治疗指南。
