Thrombosis and Inflammation in Acute Coronary Syndromes

Antiplatelet and Antithrombotic Therapy in Acute Coronary Syndrome in Patients with Chronic Kidney Disease

Author(s): Mahmut Altındal and Mustafa Arıcı

Pp: 121-139 (19)

DOI: 10.2174/9781681080291115010010

* (Excluding Mailing and Handling)

Abstract

Chronic kidney disease (CKD) and acute kidney injury (AKI) after acute coronary syndrome (ACS) are strong predictors of morbidity and mortality in patients with ACS. Patients with concomitant kidney and cardiovascular disease constitute a population that is difficult to treat. There are limited data since patients with CKD are usually excluded from cardiovascular studies. Benefits of antiplatelet and antihrombotic therapy must be balanced with risk of adverse events. Kidney function should routinely be evaluated in patients with ACS when such therapies administered. Medications should be used with caution in patients with kidney dysfunction and estimated glomerular filtration rate should be the essential measure used for dosage adjustments. Although additional data are required for evaluation of aspirin's benefit-to-risk ratio in this special population due to inconsistent findings in clinical trials, aspirin is the usual practice and recommended without dose adjustment. Unfractionated heparin, generally do not warrant specific dose adjustment in face of kidney dysfunction. Factor Xa inhibitors, low-molecular-weight heparins and direct thrombin inhibitors except argatroban are predominantly cleared by the kidneys. Reduced doses and frequent monitoring of anticoagulation are indicated when these agents are used in patients with kidney dysfunction. Dose adjustment is usually not required for clopidogrel, prasugrel and ticagrelor in patients with renal impairment. In contrast to abciximab, both eptifibatide and tirofiban are largely eliminated via renal excretion thus, careful dose tailoring is warranted among patients with kidney disease.


Keywords: Acute coronary syndrome, antiplatelet therapy, antithrombotic therapy, chronic kidney disease, glomerular filtration rate.

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      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1465
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 58766425 and j.to_ip >=58766425 )) and ((j.from_date <= 1740457904 and j.to_date >= 1740457904 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7248) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 58766425 and j.to_ip >=58766425 )) and ((j.from_date <= 1740457904 and j.to_date >= 1740457904 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7248) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 58766425 and j.to_ip >=58766425 )) and ((j.from_date <= 1740457904 and j.to_date >= 1740457904 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 7248)
      1.34msalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1699 and `b`.`banner_from_date` <= 1740457904 and `b`.`banner_to_date` >= 1740457904 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.56msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1699
      • 3: 1740457904
      • 4: 1740457904
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='4921c4269569742ce9184fd8dcf410e4'
      320μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    5Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        d1I3B4ORqAJeVuys0yzmDqP28Clf8nm2vFbXPsy4
        uc_cart_id
        4921c4269569742ce9184fd8dcf410e4
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/7248" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/7248
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
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        session_attributes
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        array:5 [ "_token" => "d1I3B4ORqAJeVuys0yzmDqP28Clf8nm2vFbXPsy4" "uc_cart_id" => "4921c4269569742ce9184fd8dcf410e4" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/7248" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-25 04:31:44GET/chapter/7248112197