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Antiplatelet agents for adults with chronic kidney disease?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1392 (Published 06 March 2013) Cite this as: BMJ 2013;346:f1392

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Antiplatelet agents do not prevent deaths from cardiovascular disease or any other cause in adults with chronic kidney disease. In the first comprehensive meta-analysis in this patient group, drugs such as aspirin and clopidogrel reduced the risk of myocardial infarction (relative risk 0.87, 95% CI 0.76 to 0.99), but not stroke or mortality. The same drugs increased the risk of major bleeding by 33% (1.33, 1.10 to 1.65) and the risk of minor bleeding by 49% (1.49, 1.12 to 1.97). Results were consistent across all types of antiplatelet drug and all stages of chronic kidney disease.

People with chronic kidney disease seem to have less to gain and more to lose from antiplatelet treatment than other adults with a high risk of cardiovascular disease, say the authors. Their cardiovascular disease is dominated by heart failure, arterial stiffness, and sudden arrhythmias, rather than arterial thromboses. The trade off is likely to be particularly unfavourable for adults with early stage kidney disease. In this subgroup, antiplatelet agents prevented two myocardial infarctions but caused seven major bleeds for every 1000 adults treated for one year.

The authors pooled data from 44 trials that compared antiplatelet treatment with placebo or no treatment. They weren’t able to compare different drugs with confidence or explore the effects in adults with renal transplants. Effects on vascular access were mixed.

Notes

Cite this as: BMJ 2013;346:f1392