Management and practice of antiplatelet therapy after percutaneous coronary intervention in patient with chronic kidney disease undergoing hemodialysis
10.3760/cma.j.cn114015-20240617-00456
- VernacularTitle:长期血液透析肾病患者经皮冠状动脉介入治疗术后抗血小板治疗管理与实践
- Author:
Hao TANG
1
;
Yan QIAO
1
;
Yan YAN
1
;
Shaoping NIE
1
Author Information
1. 首都医科大学附属北京安贞医院心内科冠心病中心，北京 100029
- Publication Type:Journal Article
- Keywords:
Kidney failure, chronic;
Dialysis;
Percutaneous coronary intervention;
Stent thrombosis;
Dual antiplatelet therapy;
Clopidogrel;
Chronic kidney disease
- From:
Adverse Drug Reactions Journal
2025;27(2):115-119
- CountryChina
- Language:Chinese
-
Abstract:
With the increasing prevalence of chronic kidney disease (CKD) and the progress of renal replacement therapy, there were more and more patients with long-term hemodialysis (hemodialysis). Cardiovascular diseases were the leading cause of death among hemodialysis patients, and a lot of these patients needed to be treated with percutaneous coronary intervention (PCI). However, hemodialysis patients had higher risks of both bleeding and thrombotic events, which made it difficulty to select drugs and their dosages for post-PCI dual antiplatelet therapy in clinical practice, and the impacts of hemodialysis on dual antiplatelet therapy were still unclear. We reported a 65-year-old male patient with CKD, who was on long-term hemodialysis treatment and underwent PCI for acute non-ST segment elevation myocardial infarction. The patient was given dual antiplatelet therapy with aspirin and clopidogrel after the procedure, and on the fourth day after PCI (14 hours after restarting hemodialysis), he developed subacute stent thrombosis due to clopidogrel resistance, which was resolved after revascularization. Based on the treatment experience in this patient and review of relevant literature, we proposed recommendations on management of dual antiplatelet therapy in long-term hemodialysis patients from 3 aspects: drug selection, clopidogrel dose adjustment, and hemodialysis management after PCI.
