Bernard G. Jaar, MD, MPH
What are the effects of antiplatelet therapy on mortality and cardiovascular (CV) events in patients with chronic kidney disease (CKD)?
Included studies compared antiplatelet agents with control (placebo, standard care, or no treatment) in adults with CKD. Trials with follow-up < 2 months in duration and those that did not provide data in an extractable format were excluded. Outcomes were mortality, CV events, and bleeding.
EMBASE/Excerpta Medica (1980 to Nov 2011), Cochrane Central Register of Controlled Trials (2011, Issue 4), Cochrane Renal Group's specialized register (Nov 2011), and reference lists of retrieved publications were searched for randomized controlled trials (RCTs). Investigators were contacted. 27 RCTs (n = 10 973) of patients with stable or no CV disease met the section criteria. Median follow-up was 12 months. Study quality was low to moderate as assessed by the Grading of Recommendations Assessment, Development, and Evaluation guidelines.
Meta-analysis showed that antiplatelet therapy reduced risk for myocardial infarction and increased minor bleeding (Table). Groups did not differ for all-cause mortality, CV mortality, stroke, or major bleeding (Table).
In patients with chronic kidney disease, antiplatelet therapy reduces myocardial infarction, but not mortality, and increases minor bleeding.
Antiplatelet therapy vs control in patients with chronic kidney disease and stable or no cardiovascular disease*
*Abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from control event rates and relative risks in article using a random-effects model.
Bernard G. Jaar. Review: Antiplatelet therapy does not reduce mortality in chronic kidney disease. Ann Intern Med. 2012;157:JC2–8. doi: 10.7326/0003-4819-157-4-201208210-02008
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Published: Ann Intern Med. 2012;157(4):JC2-8.
Chronic Kidney Disease, Nephrology.
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