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Antiplatelet Therapy in End-stage Renal Disease Patients on Maintenance Dialysis: a State-of-the-art Review

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Abstract

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. Potent antiplatelet therapy may help mitigate this risk. Nonetheless, ERSD patients are also at increased risk of bleeding due to their complex vascular milieu, which limits the routine use of potent P2Y12 inhibitors. Moreover, these patients are often underrepresented or excluded from major clinical trials leaving a significant gap in existing knowledge. Understanding the mechanisms of this paradox may serve as a benchmark for the development of ESRD trials. The present review aims to provide an overview of the pathophysiological nature of increased bleeding and ischaemic risks in ERSD patients as well as summarize available evidence of antiplatelet use and propose new concepts to guide physicians in selecting appropriate drug regimes for this high-risk cohort.

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Data Availability

Data sharing is not applicable to this review article as no new data were created or analysed in this study.

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Author information

Authors and Affiliations

  1. Darlington Memorial Hospital, Darlington, UK

    Pietro Igor Ponchia

  2. Royal Brompton Hospital, London, UK

    Raheel Ahmed

  3. Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK

    Mohamed Farag & Mohammad Alkhalil

  4. Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, NE7 7DN, UK

    Mohammad Alkhalil

  5. Department of Cardiothoracic Services, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne, NE7 7DN, UK

    Mohammad Alkhalil

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  1. Pietro Igor Ponchia
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  2. Raheel Ahmed
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  3. Mohamed Farag
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  4. Mohammad Alkhalil
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Pietro Ponchia, Raheel Ahmed, Mohamed Farag, and Mohammad Alkhalil. The first draft of the manuscript was written by Pietro Ponchia and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mohammad Alkhalil.

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Ponchia, P., Ahmed, R., Farag, M. et al. Antiplatelet Therapy in End-stage Renal Disease Patients on Maintenance Dialysis: a State-of-the-art Review. Cardiovasc Drugs Ther 37, 975–987 (2023). https://doi.org/10.1007/s10557-022-07366-4

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