While having no effect on MI or mortality, antiplatelet therapy in
patients with chronic kidney disease and ACS was associated with an increased
risk of major bleeding in a recent systematic review and meta-analysis
published in the Annals of Internal Medicine.
The study also found that despite preventing MI among those with stable
or no CVD and chronic kidney disease (CKD), antiplatelet therapy did not
improve mortality risk and in fact increased the risk of minor bleeding.
The analysis consisted of 9,969 patients with CKD who had ACS or
underwent PCI from nine trials, all of which were post hoc subgroup analyses
for CKD, along with 11,701 patients with CKD and stable or no CVD from 31
Among those with CKD who had ACS or underwent PCI, antiplatelet therapy
was associated with an increased risk of bleeding, both major (RR=1.40; 95% CI,
1.05-1.86) and minor (RR=1.47; 95% CI, 1.25-1.72), while having no significant
benefit on MI (RR=0.89; 95% CI, 0.76-1.05), or all-cause (RR=0.89; 95% CI,
0.75-1.05) or CV (RR=0.96; 95% CI, 0.79-1.16) mortality. For patients with CKD
and stable or no CVD, antiplatelet therapy was linked to a reduction in MI
(RR=0.66; 95% CI, 0.51-0.87), but no decrease in all-cause (RR=0.87; 95% CI,
0.61-1.24) or CV (RR=0.91; 95% CI, 0.60-1.36) mortality and a significant
increase in minor bleeding (RR=1.70; 95% CI, 1.44-2.02).
For more information:
Palmer SC. Ann Intern Med. 2012;156:445-459.