Weigh up antiplatelet harm vs benefit in CKD

Glycoprotein IIb/IIa inhibitors and clopidogrel had little or no effect on myocardial infarction, death or coronary revascularisation in patients with CKD and acute coronary syndromes or who were undergoing percutaneous coronary intervention – but the increased risk of major bleeding was substantial, researchers found. 

Aspirin did show benefits, but still carried higher bleeding risk among CKD patients compared with the wider population, said co-author Professor Vlado Perkovic, executive director of The George Institute for Global Health, Sydney.

Overall, evidence was low-quality and derived from post hoc analyses but, caveats aside, he said doctors should be aware of added bleeding risks due to abnormalities in the clotting mechanism of patients with CKD.

“Use aspirin cautiously and use other antiplatelet agents with extreme caution,” he said.

“The strongest evidence was for people receiving long term

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