In people with chronic kidney disease, antiplatelet drugs reduce heart attacks but increase bleeding

Palmer SC, Di Micco L, Razavian M, et al. Antiplatelet agents for chronic kidney disease. Cochrane Database Syst Rev. 2013;2:CD008834.

Review question

What are the effects of antiplatelet drugs in people with chronic kidney disease?

Background

Chronic kidney disease is a progressive loss in kidney function over a period of months or years.

Cardiovascular disease refers to diseases that involve the heart and the system of arteries that carry blood to the body. These diseases include stroke and heart attack. Cardiovascular disease is the leading cause of sickness and death in people with chronic kidney disease.

Platelets are blood clot cells. Clots may result in stroke and heart attacks. Antiplatelet drugs prevent clot formation.

Antiplatelet drugs might be beneficial in patients with chronic kidney disease to prevent stroke and heart attacks.

How the review was done

This summary is based on a systematic review of 50 randomized controlled trials involving 27,139 people. Period of publication was 1974 to 2010.

Outcomes included heart attacks, strokes, death from all causes, death from cardiovascular disease, major and minor bleeding, kidney disease, kidney transplant failure, and dialysis.

What the researchers found

Antiplatelet drugs compared with placebo or no treatment

• Antiplatelet drugs reduced the risk of heart attacks by 13%.
• Antiplatelet drugs did not reduce death from any cause, death from stroke, or cardiovascular-related death.
• Antiplatelet drugs increased the risk of major bleeding by 33% and minor bleeding by 48%.
• For all types of dialysis access, antiplatelet drugs reduced failure of the access site by 32%.
• Antiplatelet drugs did not differ in the relative benefits or harms of treatment by drug type (aspirin, ticlopidine, or clopidogrel) or by stage of chronic kidney disease.

Comparisons among antiplatelet drugs

• Data for direct comparisons of 1 antiplatelet drug with another were limited.

Conclusion

Antiplatelet drugs (for about 12 months) lower the risk of heart attacks in people with chronic kidney disease.

Antiplatelet drugs increase major and minor bleeding.

Antiplatelet drugs (aspirin, ticlopidine, or clopidrogrel) vs placebo or no treatment in people with chronic kidney disease