title: 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.
  
  
  OBJECTIVE
  To summarize the effects of antiplatelet treatment on cardiovascular events, mortality, and bleeding in persons with CKD.
  
  
  METHODS
  Embase and Cochrane databases through November 2011 without language restriction.
  
  
  METHODS
  Randomized trials that included adults with CKD and compared antiplatelet agents with standard care, placebo, or no treatment.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 bleeding. Compared with placebo or no treatment in persons with stable or no cardiovascular disease, antiplatelet agents prevented myocardial infarction but had uncertain effects on mortality and increased minor bleeding according to generally low-quality evidence.
  
  
  CONCLUSIONS
  Data for antiplatelet agents in persons with CKD are frequently derived from post hoc analyses of trials of broader populations. Definitions for bleeding outcomes and trial duration were heterogeneous.
  
  
  CONCLUSIONS
  Benefits for antiplatelet therapy among persons with CKD are uncertain and are potentially outweighed by bleeding hazards.
  
  
  BACKGROUND
  None.
authors.affiliation: University of Otago, Christchurch, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Micco
authors.forename: Mona
authors.initials: M
authors.lastname: Razavian
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Vlado
authors.initials: V
authors.lastname: Perkovic
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Copetti
authors.forename: Giusi
authors.initials: G
authors.lastname: Graziano
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Meg
authors.initials: M
authors.lastname: Jardine
authors.forename: Angela
authors.initials: A
authors.lastname: Webster
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Sophia
authors.initials: S
authors.lastname: Zoungas
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000517:prevention & control; D015982:Bias; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D002423:Cause of Death; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D020521:Stroke / Q000401:mortality / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors