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Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease: A Systematic Review and Meta-analysis
Abstract
Background Antiplatelet agents are used to prevent cardiovascular events; however, treatment effects may differ in persons with chronic kidney disease (CKD) because atherosclerotic disease is less prevalent, whereas bleeding hazards may be increased in this population. Purpose To summarize the effects of antiplatelet treatment on cardiovascular events, mortality, and bleeding in persons with CKD. Data sources Embase and Cochrane databases through November 2011 without language restriction. Study selection Randomized trials that included adults with CKD and compared antiplatelet agents with standard care, placebo, or no treatment. Data extraction Data for populations, interventions, outcomes, and risk for bias were extracted. Quality of evidence for treatment effects on myocardial infarction, death, and bleeding was summarized by using Grading of Recommendations Assessment, Development, and Evaluation guidelines. Data synthesis Nine trials (all post hoc subgroup analyses for CKD) involving 9969 persons who had acute coronary syndromes or were undergoing percutaneous coronary intervention and 31 trials involving 11,701 persons with stable or no cardiovascular disease were identified. Low-quality evidence has found that in persons with acute coronary syndromes, glycoprotein IIb/IIIa inhibitors or clopidogrel plus standard care compared with standard care alone had little or no effect on all-cause or cardiovascular mortality or on myocardial infarction but increased serious bleed…
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“However, because of the gaps in data and negative study results, uncertainty exists over the benefits of applying proven CVD therapy in the general population to the CKD population, especially in patients with advanced kidney disease.”
From Benefits of Icosapent Ethyl Across the Range of Kidney Function in Patients With Established Cardiovascular Disease or Diabetes: REDUCE-IT RENAL (2021) · cites this paper as [27]
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Metadata
- Authors
- Palmer, S. C., Di Micco, L., Razavian, M., Craig, J. C., Perkovic, V., Pellegrini, F., Copetti, M., Graziano, G., Tognoni, G., Jardine, M., Webster, A., Nicolucci, A., Zoungas, S., & Strippoli, G. F. M.
- Affiliations
- The University of Sydney (AU)
- From University of Otago, Christchurch, New Zealand; University of Naples Federico II, Naples, Italy; The George Institute for Global Health and School of Public Health, University of Sydney, Sydney, Australia; Mario Negri Sud Consortium, Santa Maria Imbaro, Italy; Scientific Institute Casa Sollievo della Sofferenza, Foggia, Italy; Concord Repatriation General Hospital, Concord, Australia; Diaverum Medical-Scientific Office, Lund, Sweden; and University of Bari, Bari, Italy.
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2012-03-20
- Volume
- 156
- Issue
- 6
- Pages
- 445-459
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2091092840
- Cited by
- 204
- References
- 4
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 11 · 2023: 8 · 2022: 10 · 2021: 16 · 2020: 16 · 2019: 22 · 2018: 17 · 2017: 13 · 2016: 16 · 2015: 11 · 2014: 19 · 2013: 20 · 2012: 15
- FWCI
- 3.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Coronary Interventions and Diagnostics
- Keywords
- antiplatelet therapy, chronic kidney disease, glycoprotein IIb/IIIa inhibitors, clopidogrel, bleeding risk, cardiovascular mortality, myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, stable cardiovascular disease, cardiovascular events
- MeSH terms
- Cardiovascular Diseases, Cause of Death, Hemorrhage, Humans, Myocardial Infarction, Myocardial Revascularization, Platelet Aggregation Inhibitors, Bias, Stroke, Renal Insufficiency, Chronic, Acute Coronary Syndrome
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