Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations
Abstract Background The choice of the most appropriate antithrombotic regimen that balances ischemic and bleeding risks was addressed by the August 2017 European Society of Cardiologists (ESC)/European Association for Cardio-Thoracic Surgery Focused Update recommendations, which propose new evaluati...
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s12916-018-1145-0 |
| _version_ | 1811289508931436544 |
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| author | Adrian Covic Simonetta Genovesi Patrick Rossignol Philip A. Kalra Alberto Ortiz Maciej Banach Alexandru Burlacu |
| author_facet | Adrian Covic Simonetta Genovesi Patrick Rossignol Philip A. Kalra Alberto Ortiz Maciej Banach Alexandru Burlacu |
| author_sort | Adrian Covic |
| collection | DOAJ |
| description | Abstract Background The choice of the most appropriate antithrombotic regimen that balances ischemic and bleeding risks was addressed by the August 2017 European Society of Cardiologists (ESC)/European Association for Cardio-Thoracic Surgery Focused Update recommendations, which propose new evaluation scores and protocols for patients requiring a coronary stent or patients with an acute coronary syndrome, atrial fibrillation, or a high bleeding risk and indication for oral anticoagulation therapy. Discussion Numerous questions remain regarding antithrombotic regimens and risk management algorithms for both ischemic and hemorrhagic events in patients with chronic kidney disease (CKD) in various clinical scenarios. Limitations of current studies include a general ack of advanced CKD patients in major randomized controlled trials, of evidence on algorithm implementation, and of robust assessment tools for hemorrhagic risk. Herein, we aim to analyze the ESC Update recommendations and the newly implemented risk scores (DAPT, PRECISE-DAPT, PARIS) from the point of view of CKD, providing suggestions on drug choice (which combination has the best evidence), dosage, and duration (the same or different as for non-CKD population) of antithrombotics, as well as to identify current shortcomings and to envision directions of future research. Conclusion We provide an evidence-based perspective on the new proposed bleeding management protocol, with focus on the CKD population. Despite previous important steps on antithrombotic therapy of renal patients, there remain many unsolved questions for which our suggestions could fundament new randomized controlled trials and specific protocols. |
| first_indexed | 2024-04-13T03:56:03Z |
| format | Article |
| id | doaj.art-e7bd9cd32d384943a77fa483c9003520 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-04-13T03:56:03Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-e7bd9cd32d384943a77fa483c90035202022-12-22T03:03:39ZengBMCBMC Medicine1741-70152018-09-0116111110.1186/s12916-018-1145-0Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendationsAdrian Covic0Simonetta Genovesi1Patrick Rossignol2Philip A. Kalra3Alberto Ortiz4Maciej Banach5Alexandru Burlacu6Nephrology Clinic, Dialysis and Renal Transplant Center – ‘C.I. Parhon’ University HospitalDepartment of Medicine and Surgery, University of Milan-BicoccaInserm, Centre d’Investigations Cliniques-Plurithématique 14-33, Inserm U1116, CHRU NancyThe University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation TrustIIS-Fundacion Jimenez Diaz UAM, FRIAT and REDINRENDepartment of Hypertension, Chair of Nephrology and Hypertension, Medical University of LodzDepartment of Interventional Cardiology, Cardiovascular Diseases Institute, ‘Grigore T. Popa’ University of MedicineAbstract Background The choice of the most appropriate antithrombotic regimen that balances ischemic and bleeding risks was addressed by the August 2017 European Society of Cardiologists (ESC)/European Association for Cardio-Thoracic Surgery Focused Update recommendations, which propose new evaluation scores and protocols for patients requiring a coronary stent or patients with an acute coronary syndrome, atrial fibrillation, or a high bleeding risk and indication for oral anticoagulation therapy. Discussion Numerous questions remain regarding antithrombotic regimens and risk management algorithms for both ischemic and hemorrhagic events in patients with chronic kidney disease (CKD) in various clinical scenarios. Limitations of current studies include a general ack of advanced CKD patients in major randomized controlled trials, of evidence on algorithm implementation, and of robust assessment tools for hemorrhagic risk. Herein, we aim to analyze the ESC Update recommendations and the newly implemented risk scores (DAPT, PRECISE-DAPT, PARIS) from the point of view of CKD, providing suggestions on drug choice (which combination has the best evidence), dosage, and duration (the same or different as for non-CKD population) of antithrombotics, as well as to identify current shortcomings and to envision directions of future research. Conclusion We provide an evidence-based perspective on the new proposed bleeding management protocol, with focus on the CKD population. Despite previous important steps on antithrombotic therapy of renal patients, there remain many unsolved questions for which our suggestions could fundament new randomized controlled trials and specific protocols.http://link.springer.com/article/10.1186/s12916-018-1145-0AnticoagulationAntithromboticsBleedingCardiovascular diseaseChronic kidney diseaseIschemic heart disease |
| spellingShingle | Adrian Covic Simonetta Genovesi Patrick Rossignol Philip A. Kalra Alberto Ortiz Maciej Banach Alexandru Burlacu Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations BMC Medicine Anticoagulation Antithrombotics Bleeding Cardiovascular disease Chronic kidney disease Ischemic heart disease |
| title | Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations |
| title_full | Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations |
| title_fullStr | Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations |
| title_full_unstemmed | Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations |
| title_short | Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations |
| title_sort | practical issues in clinical scenarios involving ckd patients requiring antithrombotic therapy in light of the 2017 esc guideline recommendations |
| topic | Anticoagulation Antithrombotics Bleeding Cardiovascular disease Chronic kidney disease Ischemic heart disease |
| url | http://link.springer.com/article/10.1186/s12916-018-1145-0 |
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