Abstract
BackgroundThe benefits and risks of antiplatelet therapy for patients with chronic kidney disease (CKD) remain controversial. We undertook a systematic review and meta-analysis to investigate the effects of antiplatelet therapy on major clinical outcomes.MethodsWe systematically searched MEDLINE, Embase, and the Cochrane Library for trials published before April 2019 without language restriction. We included rrandomized controlled trials that involved adults with CKD and compared antiplatelet agents with controls.ResultsFifty eligible trials that included at least one event were identified, providing data for 27773patients with CKD, including 4518 major cardiovascular events and 1962 all-cause deaths. Antiplatelet therapy produced a 15% (OR, 0.85; 95% CI 0.74–0.94) reduction in the odds of major cardiovascular events (P = 0.002), a 48% reduction for access failure events (OR, 0.52; 95% CI, 0.31–0.73), but had no significantly effect on all-cause death (OR, 0.87; 95% CI, 0.71–1.01) or kidney failure events (OR, 0.87; 95% CI, 0.32–1.55). Adverse events were significantly increased by antiplatelet therapy, including major (OR, 1.33; 95% CI, 1.11–1.59) or minor bleeding (OR, 1.66; 95% CI, 1.27–2.05). Among every 1000 persons with CKD treated with antiplatelet therapy for 12 months, 23 major cardiovascular events will be prevented while nine major bleeding events will occur.ConclusionsMajor prevention with antiplatelet agents (cardiovascular events and access failure), might outweigh the risk of bleeding, and there seemed to be an overall net benefit. Individual evaluation and careful monitoring are required.
Highlights
The benefits and risks of antiplatelet therapy for patients with chronic kidney disease (CKD) remain controversial
The following databases were searched without language restriction before April 2019: MEDLINE by the Ovid, Embase, and the Cochrane Library database using relevant keywords and medical subject headings that included all spellings of known Random control trial (RCT), CKD, and antiplatelet agents
We studied six types of antiplatelet medicines, including cyclooxygenase-2 inhibitor for 12 studies, phosphodiesterase inhibitor for five studies, adenosine diphosphate P2Y12 receptor inhibitor for 15 studies, platelet glycoprotein IIb/IIIa receptor blockade for seven studies, thromboxane A2 synthase receptor inhibitor for three studies, and combined therapy for eight studies
Summary
The benefits and risks of antiplatelet therapy for patients with chronic kidney disease (CKD) remain controversial. Some random control trials (RCTs) involving a CKD population showed that more intensive platelets inhibition could be of reduced benefit in preventing major cardiovascular events [10, 11] and dialysis vascular access failure [12], whereas others suggested benefits of similar or even greater magnitude [13,14,15]. Given these uncertainties, patients with CKD have been shown to be less likely to be prescribed antiplatelet drugs, even after acute myocardial infarction [16, 17]. It is difficult for clinicians to interpret these results when counseling patients with CKD about antiplatelet therapy
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