Oral P2Y12 receptor inhibitors are commonly used drugs in patients on hemodialysis (HD) to treat acute coronary syndrome with or without percutaneous coronary intervention (PCI), and patients with stable coronary artery disease after PCI. Clopidogrel is the most commonly prescribed P2Y12 receptor inhibitor because it is effective in the general population and is not as costly as newer FDA-approved agents (prasugrel, ticagrelor). However, increasing evidence is accumulating that clopidogrel may not be as effective in reducing mortality and preventing future ischemic events in patients with kidney disease. In this review, we will explore some of the studies that form the basis for this statement and discuss potential pharmacokinetic and pharmacodynamic reasons why clopidogrel might be less effective in HD patients, as well as explore potential risks and benefits of alternatives to clopidogrel therapy.
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