Key result
Antiplatelet therapy cuts major CV events ~15% in CKD patients but increases major bleeding.
Why the study?
The benefits and risks of antiplatelet therapy for patients with chronic kidney disease remain controversial.
Does antiplatelet therapy reduce major cardiovascular events in adults with chronic kidney disease?
Meta-Analysis (n=27,773)
Does antiplatelet therapy reduce major cardiovascular events in adults with chronic kidney disease?
In patients with chronic kidney disease, antiplatelet therapy reduces major cardiovascular events and dialysis access failure but significantly increases the risk of major and minor bleeding, necessitating individualized risk-benefit assessment.
Answers are grounded in this paper and cite their sources.
Supports individualized antiplatelet use in CKD; extends meta-analytic evidence for MACE reduction despite bleeding risk.
BACKGROUND: The 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. METHODS: We 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. RESULTS: Fifty 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. CONCLUSIONS: Major 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.
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Su et al. (2019) conducted a meta-analysis in chronic kidney disease (n=27,773). Antiplatelet therapy vs. Controls was evaluated on major cardiovascular events (OR 0.85, 95% CI 0.74-0.94, p=0.002). Antiplatelet therapy in patients with chronic kidney disease significantly reduced the odds of major cardiovascular events (OR 0.85; 95% CI 0.74-0.94; P=0.002) but increased major bleeding.
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