Questions Raised About Antiplatelet Therapy in Chronic Kidney Disease

Many people develop chronic kidney disease (CKD) as they grow older, and many people with CKD take antiplatelet agents to prevent cardiovascular events. However, the efficacy of antiplatelet therapy in CKD has not been examined, despite the fact that people with CKD are more likely to die from nonatherosclerotic conditions and are more likely to have bleeding complications due to antiplatelet agents.

In a systematic review and meta-analysis published in Annals of Internal Medicine, Suetonia Palmer and colleagues examined data from   trials that enrolled nearly 10,000 participants with ACS and nearly 12,000 subjects with stable or no cardiovascular disease.

  • In the ACS group, the investigators found that antiplatelet therapy– either glycoprotein IIb/IIIa inhibitors or clopidogrel, increased the risk of serious bleeding but had little or no effect on overall mortality, CV mortality, or MI.
  • In the non-ACS group, the investigators found that antiplatelet agents helped prevent MI but had an “uncertain” effect on mortality and increased minor bleeding.

In both groups, the investigators acknowledged that the evidence was of “low or very-low quality.” They concluded that “bleeding hazards and lack of clear efficacy in reducing cardiovascular morbidity and mortality need to be acknowledged when patients with CKD are being counseled about acute or long-term antiplatelet therapy.”

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