Journal
BMC MEDICINE
Volume 16, Issue -, Pages -Publisher
BMC
DOI: 10.1186/s12916-018-1145-0
Keywords
Anticoagulation; Antithrombotics; Bleeding; Cardiovascular disease; Chronic kidney disease; Ischemic heart disease; Risk score
Categories
Funding
- Ministry of Research and Innovation, CNCS - UEFISCDI, within PNCDI III [PN-III-P4-ID-PCE-2016-0908, 167/2017]
- FIS [PI16/02057]
- FEDER funds ISCIII-RETIC REDinREN [RD16/0009]
- Comunidad de Madrid [B2017/BMD-3686 CIFRA2 CM]
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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 CardioThoracic 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.
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