title: Antiplatelet Therapy in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  This investigation might contribute to delineate the best treatment options for this high risk population.
authors.affiliation: Department of Cardiology-Policlinico Casilino, Catheter Laboratory, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Summaria
authors.affiliation: Department of Cardiology-Policlinico Casilino, Catheter Laboratory, Rome, Italy.
authors.forename: Maria B
authors.initials: MB
authors.lastname: Giannico
authors.affiliation: Department of Cardiology-Policlinico Casilino, Catheter Laboratory, Rome, Italy.
authors.forename: Giovanni P
authors.initials: GP
authors.lastname: Talarico
authors.affiliation: Department of Cardiology-Policlinico Casilino, Catheter Laboratory, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Patrizi
keywords: Antiplatelet Therapy; Clopidogrel; Drug Eluting Stent; Hemodialysis Patients; Percutaneous Coronary Interventions; Prasugrel; Ticagrelor