From the Research
For patients with stroke and ESRD, a typical 21-day dual antiplatelet regimen consists of aspirin 81 mg daily and clopidogrel 75 mg daily, with a loading dose of clopidogrel 300 mg on day 1, as this regimen aims to reduce the risk of recurrent stroke in the critical period following the initial event, as supported by the most recent study 1. The combination of aspirin and clopidogrel provides synergistic antiplatelet effects: aspirin inhibits thromboxane A2-dependent platelet activation, while clopidogrel blocks ADP-mediated platelet aggregation. Key considerations for this regimen include:
- No dose adjustment is necessary for aspirin in ESRD patients, but monitor closely for bleeding, especially gastrointestinal, as noted in 2.
- While clopidogrel doesn't require dose adjustment in ESRD, be vigilant for increased bleeding risk, as highlighted in 3.
- After 21 days, reassess the patient for long-term antiplatelet strategy, which may involve continuing dual therapy or switching to single antiplatelet therapy based on individual risk factors, taking into account the patient's response to the initial regimen and their overall clinical condition, as discussed in 1. It's essential to weigh the benefits of antiplatelet therapy against the risks, particularly in ESRD patients who are at increased risk of bleeding, as emphasized in 4 and 5. The most recent study 1 provides a comprehensive overview of the current state of antiplatelet therapy in ESRD patients, highlighting the need for careful consideration of the risks and benefits of different treatment strategies.