P NATALE1,2, S PALMER3, V SAGLIMBENE1,2, M RUOSPO1,2, M RAZAVIAN4, J CRAIG5, M JARDINE1, A WEBSTER1, G STRIPPOLI1,2
1University Of Sydney, Sydney, Australia, 2University of Bari, Bari, Italy, 3University of Otago, Christchurch, New Zealand, 4The George Institute of Global Health, Sydney, Australia, 5Flinders University, Adelaide, Australia
Aim: We carried out an update of a Cochrane review evaluating the effects of antiplatelet treatment for the prevention of cardiovascular and adverse kidney outcomes in individuals with CKD.
Background: Antiplatelet agents are widely used to prevent cardiovascular events. The risks and benefits of antiplatelet treatment may be different in people with chronic kidney disease (CKD) for whom occlusive atherosclerotic events are less prevalent, and bleeding hazards might be increased.
Methods: We selected randomised controlled trials of any antiplatelet treatment versus placebo or no treatment, or direct head-to-head antiplatelet agent studies in people with CKD. Treatment effects were estimated by random-effects meta-analysis. Evidence certainty was adjudicated using GRADE methodology.
Results: 110 studies (52424 participants) were included. Risk of bias was generally high or unclear. Antiplatelet agents probably reduce the risk of myocardial infarction (RR 0.87, 95% CI 0.76 to 0.99; moderate certainty evidence) and increase major bleeding (RR 1.35, 95% CI 1.10 to 1.65; moderate certainty evidence), and may increase the risk of minor bleeding in CKD and haemodialysis patients (RR 1.55, 95% CI 1.27 to 1.90; low certainty evidence). Limited data were available for direct head-to-head comparisons of antiplatelet drugs.
Conclusion: Antiplatelet agents probably reduce myocardial infarction and increase major bleeding, and may increase minor bleeding in CKD and haemodialysis patients. The treatment effect of direct head-to-head comparisons of antiplatelet drugs is very uncertain an rarely reported.
Patrizia Natale, Research Associate, has completed an MSc in Clinical Epidemiology at the University of Sydney, and a bachelor’s degree in Pharmacy. Patrizia is a researcher at the Centre of Kidney Research at the University of Sydney, and she has experience in Cochrane Systematic Reviews in patients with all stages of CKD (including patients undergoing dialysis and kidney transplant recipients), and in the design and conduct of randomized controlled trials and long-term cohort studies. She has completed the PhD in nephrology and kidney transplantation at the University of Bari, Italy.