| Theme |
Antiplatelet and Anticoagulation Therapy in Patients with Chronic Kidney Disease -- up to date of evidence |
| Title |
Anticoagulation and antiplatelet therapy for prevention and management of cerebrovascular disease in patients with chronic kidney disease |
| Author |
Kazuhiko Tsuruya |
Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University |
| [ Summary ] |
Hemorrhagic risk due to anticoagulation and antiplatelet therapy is considered to be high in patients with chronic kidney disease (CKD). It has been reported that warfarin therapy is effective in preventing strokes without causing an increase in hemorrhagic complications for patients with atrial fi brillation and renal impairment. On the other hand, this therapy increases the risk of hemorrhagic complications for those having severe renal impairment. It remains unknown whether warfarin prevents strokes in dialysis patients due to atrial fibrillation. Thus, cautious approaches are required when determining use of warfarin in those patients. Novel oral anticoagulant drugs have recently been developed and approved. Although these drugs reported to be useful for patients with mild renal impairment, it is not evident whether they are safe and effective for patients receiving hemodialysis. While thrombolytic therapy using a recombinant tissue plasminogen activator for acute brain infarctions has been applied to CKD patients, previous reports have demonstrated that outcomes from this therapy for dialysis patients are worse than those for patients with normal renal functions. To date, little evidence has been obtained on thrombolytic therapy for hemodialysis patients. It is necessary to establish corroborating evidence concerning the safety and efficacy of these treatments. |