Chronic kidney disease has been identified as an independent cardiovascular risk factor. The morbidity
and mortality due to cardiovascular disease are higher among chronic kidney disease patients when compared with
patients with normal kidney function. Although P2Y12 inhibitors (eg. clopidogrel) are associated with increased
survival rates after a myocardial infarction, most of the clinical trials excluded End-Stage Renal Disease (ESRD)
patients. Besides, non-responders to P2Y12 inhibitors have been identified as at risk of cardiovascular adverse
events and non-responder prevalence is higher among ESRD than in any other population. Recent data questioned
the benefits from P2Y12 inhibitors among chronic kidney disease patients. This systematic review aimed to describe pharmacokinetics
(PK) and pharmacodynamics (PD) evidence data among 3 widely prescribed P2Y12 inhibitors. Clopidogrel and prasugrel are bioactivated
by the cytochromes P450 (CYP) while ticagrelor is already active. PD data used different assays among which the VerifyNow®
which showed intravariability before and after dialysis. The potential explanation of modulated PK/PD parameters among ESRD patients
will be addressed. Absorption as well as metabolism is diminished in ESRD patients. It could potentially lead to absence of clopidogrel
or prasugrel bioactivation or ticagrelor accumulation. Evidence-based recommendation regarding the best option for antiaggregation secondary
to percutaneous intervention in this high risk population is still lacking.
Keywords: Antiaggregant, chronic kidney disease, clopidogrel, prasugrel, ticagrelor.
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