From the Research
For patients with stroke and ESRD, a typical 21-day dual antiplatelet therapy regimen would consist of aspirin 81 mg daily plus clopidogrel 75 mg daily, as this combination has been shown to reduce the risk of recurrent stroke while balancing the increased bleeding risk in ESRD patients 1.
Key Considerations
- Start with a loading dose of clopidogrel 300 mg on day 1, followed by 75 mg daily for the remaining 20 days.
- Aspirin 81 mg should be given daily for the entire 21-day period.
- No dose adjustment is typically needed for aspirin in ESRD patients, but close monitoring for bleeding is essential.
- While clopidogrel doesn't require dose adjustment for renal impairment, its efficacy may be reduced in ESRD patients due to altered metabolism.
Monitoring and Precautions
- Consider platelet function testing to ensure adequate antiplatelet effect.
- Monitor for signs of bleeding, particularly gastrointestinal, and assess renal function regularly.
- The combination of aspirin and clopidogrel works synergistically to inhibit platelet aggregation through different mechanisms, providing more comprehensive protection against thrombotic events in the immediate post-stroke period.
Evidence Base
- A study published in 2014 found that antiplatelet therapy, especially aspirin, offers safe and effective treatment for ischemic stroke prevention in patients with end-stage renal disease undergoing dialysis 1.
- More recent studies, such as the 2023 review on antiplatelet therapy in ESRD patients, support the use of dual antiplatelet therapy in this population, but highlight the need for careful consideration of the risks and benefits 2.