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Antiplatelet agents for chronic kidney disease
Patrizia Natale1,2,3, Suetonia C Palmer4, Valeria M Saglimbene1,2
1Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
The Cochrane Database of Systematic Reviews
|February 28, 2022
Summary
Antiplatelet agents likely reduce myocardial infarction but increase major bleeding in chronic kidney disease (CKD) patients. These drugs do not appear to reduce overall death, and their comparative effects are uncertain.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Antiplatelet agents are standard for cardiovascular event prevention.
- Their use in chronic kidney disease (CKD) presents unique risks and benefits due to altered event prevalence and increased bleeding hazards.
- This review is an update of a 2013 analysis on antiplatelet therapy in CKD populations.
Purpose of the Study:
- To evaluate the benefits and harms of antiplatelet agents in individuals with any stage of CKD.
- Included CKD populations encompass those not on renal replacement therapy, dialysis patients, and kidney transplant recipients.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched Cochrane Kidney and Transplant Register, CENTRAL, MEDLINE, EMBASE, ICTRP, and ClinicalTrials.gov.
- Included 113 RCTs (51,959 participants) comparing antiplatelet agents to placebo or other antiplatelet agents.
Main Results:
- Antiplatelet agents probably reduce myocardial infarction (moderate certainty).
- They likely increase major bleeding events (moderate certainty) and minor bleeding (low certainty) in CKD and dialysis patients.
- Effects on stroke and all-cause mortality are uncertain (very low to low certainty); uncertain effects on other kidney-specific outcomes.
- Reduced early dialysis vascular access thrombosis and doubling of serum creatinine observed (low certainty).
Conclusions:
- Antiplatelet agents likely reduce myocardial infarction but increase major bleeding in CKD patients.
- These agents do not appear to reduce all-cause or cardiovascular death in this population.
- Comparative effectiveness and safety of different antiplatelet agents remain uncertain.
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