William Kussmaul, MD
Potential Conflicts of Interest: None disclosed.
Kussmaul W.; Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease. Ann Intern Med. 2012;157:302. doi: 10.7326/0003-4819-157-4-201208210-00023
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Published: Ann Intern Med. 2012;157(4):302.
TO THE EDITOR:
Palmer and colleagues (1) have usefully collected information on the use of antiplatelet agents in patients who have both coronary artery disease and chronic kidney disease (CKD). They conclude that the benefits of both primary and secondary prevention are uncertain and that patients who have CKD may have a greater risk for bleeding. The review also implies that these agents should not be used in patients with CKD until better data are available.
Unfortunately, Palmer and colleagues may have done a disservice to the many patients with CKD who have coronary stents and to their physicians. Almost all patients receiving stents are required to take aspirin and a thienopyridine (most often clopidogrel) for 30 days or up to 12 months, depending on the type of stent, to prevent acute coronary stent thrombosis, a very dangerous event.
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