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A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy?
Cardiovasc Drugs Ther 2018; 32(5):463-475CD

Abstract

PURPOSE

A timely pharmacoinvasive strategy consisting of thrombolytic therapy (TT) plays a pivotal role in three major scenarios: acute ischemic stroke (AIS), acute myocardial infarction (STEMI), and massive pulmonary embolism (PE). Presence of advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m2), known to disturb thrombotic/thrombolytic equilibrium, causes difficulties for clinicians in evaluating risk-benefit balance, as current guidelines do not address the relationship between TT and the advanced CKD. This narrative review aims to evaluate the most important scientific resources regarding the evidences, benefits, and risks of using thrombolytics in advanced CKD.

METHODS

We searched the electronic database of PubMed for studies evaluating the relationship between renal dysfunction and TT in patients with STEMI, AIS, and massive PE. Randomized controlled trials (RCTs), observational studies including prospective or retrospective cohort studies, reviews, meta-analyses, and guidelines were included if referring to TT for one of the three scenarios in advanced CKD.

RESULTS

Prothrombotic conditions in CKD, associated with an increased risk of hemorrhages, can affect the safety and efficacy of TT. Concerns regarding in-hospital bleeding events and poor clinical outcomes subsequent to TT in advanced CKD continue to cause underutilization or delaying routine reperfusion therapy.

CONCLUSIONS

The impact of TT on the outcomes of advanced CKD patients is poorly understood to date, with scarce data available in current guidelines and conflicting results from observational studies. Until evidence-based data from RCTs will be obtained, the clinical challenge of maximizing benefits for this high-risk subgroup lays in the hands of practicing clinicians.

Authors+Show Affiliations

Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania. University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania.Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania. bogdan.artene@yahoo.com. University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania. bogdan.artene@yahoo.com.University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania. Nephrology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30187347

Citation

Burlacu, Alexandru, et al. "A Narrative Review On Thrombolytics in Advanced CKD: Is It an Evidence-Based Therapy?" Cardiovascular Drugs and Therapy, vol. 32, no. 5, 2018, pp. 463-475.
Burlacu A, Artene B, Covic A. A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy? Cardiovasc Drugs Ther. 2018;32(5):463-475.
Burlacu, A., Artene, B., & Covic, A. (2018). A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy? Cardiovascular Drugs and Therapy, 32(5), pp. 463-475. doi:10.1007/s10557-018-6824-8.
Burlacu A, Artene B, Covic A. A Narrative Review On Thrombolytics in Advanced CKD: Is It an Evidence-Based Therapy. Cardiovasc Drugs Ther. 2018;32(5):463-475. PubMed PMID: 30187347.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy? AU - Burlacu,Alexandru, AU - Artene,Bogdan, AU - Covic,Adrian, PY - 2018/9/7/pubmed PY - 2019/5/7/medline PY - 2018/9/7/entrez KW - Acute ischemic stroke KW - Acute myocardial infarction KW - Advanced chronic kidney disease KW - Fibrinolysis KW - Pulmonary embolism KW - Thrombolysis SP - 463 EP - 475 JF - Cardiovascular drugs and therapy JO - Cardiovasc Drugs Ther VL - 32 IS - 5 N2 - PURPOSE: A timely pharmacoinvasive strategy consisting of thrombolytic therapy (TT) plays a pivotal role in three major scenarios: acute ischemic stroke (AIS), acute myocardial infarction (STEMI), and massive pulmonary embolism (PE). Presence of advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m2), known to disturb thrombotic/thrombolytic equilibrium, causes difficulties for clinicians in evaluating risk-benefit balance, as current guidelines do not address the relationship between TT and the advanced CKD. This narrative review aims to evaluate the most important scientific resources regarding the evidences, benefits, and risks of using thrombolytics in advanced CKD. METHODS: We searched the electronic database of PubMed for studies evaluating the relationship between renal dysfunction and TT in patients with STEMI, AIS, and massive PE. Randomized controlled trials (RCTs), observational studies including prospective or retrospective cohort studies, reviews, meta-analyses, and guidelines were included if referring to TT for one of the three scenarios in advanced CKD. RESULTS: Prothrombotic conditions in CKD, associated with an increased risk of hemorrhages, can affect the safety and efficacy of TT. Concerns regarding in-hospital bleeding events and poor clinical outcomes subsequent to TT in advanced CKD continue to cause underutilization or delaying routine reperfusion therapy. CONCLUSIONS: The impact of TT on the outcomes of advanced CKD patients is poorly understood to date, with scarce data available in current guidelines and conflicting results from observational studies. Until evidence-based data from RCTs will be obtained, the clinical challenge of maximizing benefits for this high-risk subgroup lays in the hands of practicing clinicians. SN - 1573-7241 UR - https://www.unboundmedicine.com/medline/citation/30187347/A_Narrative_Review_on_Thrombolytics_in_Advanced_CKD:_Is_it_an_Evidence-Based_Therapy L2 - https://doi.org/10.1007/s10557-018-6824-8 DB - PRIME DP - Unbound Medicine ER -