Prolonged dual antiplatelet therapy in renal failure: a challenging trade-off

Patients with renal failure and coronary artery disease (CAD) represent a complex and delicate cohort. Obviously, their management can be challenging and requires attention and expertise. Globally, the prevalence of chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m² and/or the presence of albuminuria, seems to constantly increase with CKD now having evolved as a global public health issue (1,2). Nowadays, the most important factors promoting the development of CKD worldwide include aging, obesity, diabetes, hypertension and atherosclerotic disease (1-3). Renal failure is not only the consequence of manifold systemic diseases, but also has systemic adverse effects and is related to high morbidity and mortality, even at an early stage (4,5). Among patients with established cardiovascular disease, CKD is related to a higher rate of adverse events, including atherothrombotic manifestations and hemorrhagic events (3). Taken together, those factors contribute to the massive increase in mortality in patients with both CAD and CKD (6).