title: Oral antiplatelet drugs in patients with chronic kidney disease (CKD): a review.
abstract: Oral Antiplatelet Drugs (OAD) have a proven track record in the risk reduction of major cardiovascular events in patients with cardiovascular disease and normal kidney function. However, major gaps exist in our understanding of their effects on thrombosis and bleeding in chronic kidney disease (CKD). Clinical practice guidelines are ambiguous about use of such drugs in CKD patients, because patients with moderate to severe CKD were systematically excluded from clinical trials evaluating the efficacy and safety of OAD. Paradoxically, CKD patients are at high risk of thrombosis and major bleeding events. Thus, choosing the right combination of OAD for cardiovascular protection in these patients is challenging. Patients with CKD exhibit high rates of OAD hyporesponsiveness. It is, therefore, imperative to explore the mechanisms responsible for poor response to OAD in CKD patients in order to use these drugs more safely and effectively. This review explores suggested mechanisms of platelet dysfucntion in CKD patients and the available evidence on the efficacy and safety of oral antiplatelet drugs in patients with renal dysfunction.
authors.affiliation: New York University Langone Medical Center, 530 1st Ave skirball 9V, New York, NY, 10016, USA. homam.ibrahim@nyumc.org.
authors.forename: Homam
authors.identifier: http://orcid.org/0000-0002-6728-3143
authors.initials: H
authors.lastname: Ibrahim
authors.affiliation: Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D013927:Thrombosis / Q000209:etiology
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Antiplatelet drugs; Chronic kidney disease; Platelet dysfunction in CKD