Patients on dialysis constitute a major healthcare burden with high prevalence of
coronary artery disease frequently requiring coronary revascularization. Prior studies have reported high complications rates with revascularization in patients on dialysis. However, information on the use
glycoprotein and
direct thrombin inhibitors in this patient population undergoing percutaneous revascularization is limited. We retrospectively analyzed the procedural success and in-hospital outcomes of
percutaneous coronary revascularization in 56 consecutive patients on dialysis compared with 524 patients without
renal failure, between January 2001 and August 2007 at our facility. Additionally, we also analyzed the
off-label use of
glycoprotein IIb/IIIa (
GP IIb/IIIa) inhibitors during revascularization in this high-risk group of patients to evaluate for possible increased
bleeding complications. In the study group, 7 interventions were performed on
peritoneal dialysis and 49 on
hemodialysis patients. Sixty-one percent of these patients had
diabetes mellitus. A total of 72 lesions were intervened upon; 12 underwent angioplasty and 60 underwent stenting. Four of 72 interventions were not successful, giving a procedural success rate of 94%. There were 6 immediate complications (10.7%), but no deaths. Thirty-two patients (57%) received
GP IIb/IIIa inhibitors while
direct thrombin inhibitors were used during
percutaneous coronary intervention in 11(20%) patients. There were no
bleeding complications with use of either
GP IIb/IIIa inhibitors or
direct thrombin inhibitors. In our experience,
percutaneous coronary intervention has high procedural success in dialysis patients and concomitant use of
GP IIb/IIIa inhibitors is not associated with any major
bleeding complications, making this a feasible, safe and effective revascularization option for patients on dialysis; however, this merits further study in a randomized prospective trial.