Kidney Week

Abstract: FR-OR121

Benefits and Harms of Dual Antiplatelet Therapy in CKD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Session Information

• Towards Better Medication Usage in Patients with CKD
  October 26, 2018 | Location: 26A, San Diego Convention Center
  Abstract Time: 06:18 PM - 06:30 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Cheng, Lap Pui, The George Institute for Global Health, Sydney, New South Wales, Australia

Lap Pui Cheng, MD

• Ha, Jeffrey, The George Institute for Global Health, Sydney, New South Wales, Australia

Jeffrey Ha,

• Tong, Matthew Hoyan, St George & Sutherland Clinical School, UNSW Medicine, Sydney, New South Wales, Australia

Matthew Hoyan Tong,

• Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia

Brendon Lange Neuen,

• Jun, Min, The George Institute for Global Health, Sydney, New South Wales, Australia

Min Jun,

• Jardine, Meg J., The George Institute for Global Health, Sydney, New South Wales, Australia

Meg J. Jardine,

• Gallagher, Martin P., The George Institute for Global Health, Sydney, New South Wales, Australia

Martin P. Gallagher,

• Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Manish M. Sood,

• Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada

Amit X. Garg,

• Perkovic, Vlado, The George Institute for Global Health, Sydney, New South Wales, Australia

Vlado Perkovic,

• Badve, Sunil V., The George Institute for Global Health, Sydney, New South Wales, Australia

Sunil V. Badve,

Background

Dual antiplatelet therapy (DAPT) is the standard of care in coronary artery disease. Despite the high burden of cardiovascular disease in chronic kidney disease (CKD), the role of DAPT in improving outcomes in CKD has not been systematically studied. The aim of this systematic review was to study the benefits and harms of DAPT in CKD.

Methods

Electronic databases were searched for randomized controlled trials (RCT) that included CKD patients (stage 3-5D or proteinuria) and evaluated the effect of DAPT on cardiovascular outcomes with ≥3 months follow up. Treatment effects were summarized using random-effects analysis.

Results

Eleven trials (13628 participants) compared DAPT to a single antiplatelet agent (6 trials), placebo (3 trials), or no study medication (2 trials). DAPT interventions were aspirin/dipyridamole (5 trials) and aspirin/P2Y12 inhibitor (6 trials). Compared to the control group, DAPT reduced the risk of major adverse cardiovascular events (4 trials, risk ratio [RR] 0.87, 95%CI 0.78, 0.97), myocardial infarction (5 trials, RR 0.76, 95%CI 0.61, 0.92), and stroke (6 trials, RR 0.81, 95%CI 0.68, 0.94). There were no differences in risk of cardiovascular death (7 trials, RR 0.95, 95%CI 0.76, 1.14), all-cause death (10 trials, RR 0.92, 95%CI 0.82, 1.03), and major bleeding (8 trials, RR 1.36, 95%CI 0.98, 1.73) between DAPT and control group. Three other trials (6239 participants) compared DAPT using aspirin/P2Y12 inhibitor to DAPT. Compared to aspirin/clopidogrel, aspirin plus ticagrelor or prasugrel reduced the risk of all-cause death (2 trials, RR 0.74, 95%CI 0.6, 0.88); and with no differences for major adverse cardiovascular events (2 trials, RR 0.88, 95%CI 0.61, 1.14), and major bleeding (3 trials, RR 0.93, 95%CI 0.37, 1.48). Overall, 4 trials included dialysis patients (1860 participants); 5 trials excluded dialysis patients (13725 participants); 2 trials did not include advanced CKD (stages 4-5) (372 participants); and 3 trials did not report the lower threshold of renal function for exclusion (3910 participants).

Conclusion

DAPT improved cardiovascular outcomes in early stages of CKD. However, there is insufficient evidence to conclude whether patients with advanced CKD derive benefit from DAPT.