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Meta-Analysis
. 2019 Aug 7;20(1):309.
doi: 10.1186/s12882-019-1499-3.

Effect of antiplatelet therapy on cardiovascular and kidney outcomes in patients with chronic kidney disease: a systematic review and meta-analysis

Xiaole Su  1   2 , Bingjuan Yan  2 , Lihua Wang  2 , Jicheng Lv  3 , Hong Cheng  1 , Yipu Chen  4
Affiliations
Meta-Analysis

Effect of antiplatelet therapy on cardiovascular and kidney outcomes in patients with chronic kidney disease: a systematic review and meta-analysis

Xiaole Su et al. BMC Nephrol. .

Abstract

Background: The benefits and risks of antiplatelet therapy for patients with chronic kidney disease (CKD) remain controversial. We undertook a systematic review and meta-analysis to investigate the effects of antiplatelet therapy on major clinical outcomes.

Methods: We systematically searched MEDLINE, Embase, and the Cochrane Library for trials published before April 2019 without language restriction. We included rrandomized controlled trials that involved adults with CKD and compared antiplatelet agents with controls.

Results: Fifty eligible trials that included at least one event were identified, providing data for 27773patients with CKD, including 4518 major cardiovascular events and 1962 all-cause deaths. Antiplatelet therapy produced a 15% (OR, 0.85; 95% CI 0.74-0.94) reduction in the odds of major cardiovascular events (P = 0.002), a 48% reduction for access failure events (OR, 0.52; 95% CI, 0.31-0.73), but had no significantly effect on all-cause death (OR, 0.87; 95% CI, 0.71-1.01) or kidney failure events (OR, 0.87; 95% CI, 0.32-1.55). Adverse events were significantly increased by antiplatelet therapy, including major (OR, 1.33; 95% CI, 1.11-1.59) or minor bleeding (OR, 1.66; 95% CI, 1.27-2.05). Among every 1000 persons with CKD treated with antiplatelet therapy for 12 months, 23 major cardiovascular events will be prevented while nine major bleeding events will occur.

Conclusions: Major prevention with antiplatelet agents (cardiovascular events and access failure), might outweigh the risk of bleeding, and there seemed to be an overall net benefit. Individual evaluation and careful monitoring are required.

Keywords: Antiplatelet therapy; Cardiovascular events; Chronic kidney disease; Meta-analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Process for the identification of eligible studies
Fig. 2
Fig. 2
Forest plot for major cardiovascular events. Major cardiovascular events were defined as a composite, including fatal or non-fatal myocardial infarction, fatal or non-fatal stroke, coronary artery revascularization, and cardiovascular death. CI confidence interval, N number of trials
Fig. 3
Fig. 3
Summary of the odds radios of all outcomes. Major cardiovascular events were defined as a composite, including fatal or non-fatal myocardial infarction, fatal or non-fatal stroke, coronary artery revascularization, and cardiovascular death. Kidney failure events were defined as more than 25% or 50% decrease in eGFR, doubling of serum creatinine, or end-stage renal disease (ESRD). N number of trials
See this image and copyright information in PMC

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