What is the use of Ticagrelor (antiplatelet medication) in patients with Impaired renal function (dialysis)?

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From the Research

Ticagrelor can be used in patients on dialysis without dose adjustment, as its pharmacokinetics and pharmacodynamics are not significantly altered in patients with impaired renal function, as shown in a study published in the European journal of clinical pharmacology 1.

Key Considerations

  • The standard dosing of ticagrelor is a 180 mg loading dose followed by 90 mg twice daily, which can be used in patients with acute coronary syndrome or those undergoing percutaneous coronary intervention.
  • Ticagrelor does not require hepatic activation to its active form, making it more predictable in its antiplatelet effect compared to clopidogrel.
  • Ticagrelor is primarily metabolized by the liver and only minimally cleared by the kidneys, with less than 1% excreted unchanged in urine, which is why no dose adjustment is needed for renal impairment or dialysis.
  • However, clinicians should monitor these patients closely for bleeding complications, as dialysis patients generally have a higher bleeding risk.
  • When using ticagrelor in dialysis patients, it should be combined with low-dose aspirin (usually 81 mg daily) unless contraindicated.
  • The duration of therapy typically ranges from 6-12 months after acute coronary syndrome or stent placement, but may be individualized based on the patient's thrombotic and bleeding risk profile.

Important Interactions

  • Angiotensin receptor blockers (ARBs) may worsen renal function and increase the risk of dyspnea in patients taking ticagrelor, as reported in a study published in Clinical cardiology 2.
  • Clinicians should be cautious when using ticagrelor in patients with severe renal insufficiency, as the risk of bleeding may be increased, as shown in a study published in the Journal of interventional cardiology 3.

Clinical Implications

  • Ticagrelor is a viable option for patients on dialysis who require antiplatelet therapy, but clinicians should carefully weigh the benefits and risks of treatment.
  • Close monitoring of patients on ticagrelor is essential to minimize the risk of bleeding complications and other adverse events.
  • Further studies are needed to fully understand the effects of ticagrelor in patients with impaired renal function and to optimize its use in this population.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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