Antiplatelet therapy that inhibits blood clotting can be life-saving for individuals at high risk for cardiovascular disease or stroke. At first glance, this should apply to patients with chronic kidney disease (CKD), who are more likely to die of cardiovascular disease than of any other cause. But nonatherosclerotic conditions such as cardiac failure, sudden cardiac death, and arrhythmia are more common causes of cardiovascular events in individuals with CKD than in the general population, and the bleeding risk of antiplatelet agents may be greater among people with CKD because of impaired hemostasis.
Investigators recently published a review in the Annals of Internal Medicine on the benefits and harms of antiplatelet agents in these patients, focusing on cardiovascular events, mortality, and bleeding.
“Until now, data from studies done in the general population were extrapolated to people with chronic kidney disease,” said senior author Giovanni Strippoli, MD, PhD, who holds titles at the school of public health at the University of Sydney in Australia, the Mario Negri Sud Consortium in Italy, and Diaverum in Sweden. “Previous research from our group and others has shown that such extrapolations could be very dangerous, and interventions that may be very good in the general population may have no effect or even be harmful in people with chronic kidney disease
Paying particular attention to patients with CKD while conducting clinical trials will only become more important. Approximately 10 percent to 15 percent of the adult population worldwide have the disease, and its prevalence is on the rise because of increasing rates of diabetes and obesity.