Antiplatelet therapy in the management of cardiovascular disease in patients with CKD: What is the evidence?

Nishank Jain, S. Susan Hedayati, Ravindra Sarode, Subhash Banerjee, Robert F. Reilly

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Antiplatelet agents (APAs) are proven to reduce risk of major cardiovascular events in patientswith cardiovascular disease and normal kidney function. With recent post hoc analyses of large trials questioning the safety and efficacy of APAs in CKD, major gaps exist in our understanding of platelet aggregability and the effects of APAs on thrombosis and bleeding in CKD. Clinical practice guidelines are ambiguous about use of such agents in CKD patients, because patients with moderate to advanced CKD were systematically excluded from clinical trials of APAs. CKD patients experience excessive rates of cardiovascular thrombotic events, yet paradoxically are at higher risk formajor bleedingwhile receiving APAs. Furthermore, observational studies suggest that CKDpatients may exhibit poor response to APAs. High residual platelet aggregability, as determined by inhibition of platelet aggregation, is associated with increased risk for cardiovascular events. In addition, metabolism of certain APAs may be altered in CKD patients. It is, therefore, imperative to explore the mechanisms responsible for poor response to APAs in CKD patients in order to use these drugsmore safely and effectively. This review identifies the knowledge gaps and future trials needed to address those issues with the use of APAs in CKD patients.

Original languageEnglish (US)
Pages (from-to)665-674
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number4
DOIs
StatePublished - Apr 5 2013

Fingerprint

Platelet Aggregation Inhibitors
Cardiovascular Diseases
Therapeutics
Blood Platelets
Platelet Aggregation
Practice Guidelines
Observational Studies
Thrombosis
Clinical Trials
Hemorrhage
Kidney
Safety

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

@article{842a1053b488427ba455310ad117249e,
title = "Antiplatelet therapy in the management of cardiovascular disease in patients with CKD: What is the evidence?",
abstract = "Antiplatelet agents (APAs) are proven to reduce risk of major cardiovascular events in patientswith cardiovascular disease and normal kidney function. With recent post hoc analyses of large trials questioning the safety and efficacy of APAs in CKD, major gaps exist in our understanding of platelet aggregability and the effects of APAs on thrombosis and bleeding in CKD. Clinical practice guidelines are ambiguous about use of such agents in CKD patients, because patients with moderate to advanced CKD were systematically excluded from clinical trials of APAs. CKD patients experience excessive rates of cardiovascular thrombotic events, yet paradoxically are at higher risk formajor bleedingwhile receiving APAs. Furthermore, observational studies suggest that CKDpatients may exhibit poor response to APAs. High residual platelet aggregability, as determined by inhibition of platelet aggregation, is associated with increased risk for cardiovascular events. In addition, metabolism of certain APAs may be altered in CKD patients. It is, therefore, imperative to explore the mechanisms responsible for poor response to APAs in CKD patients in order to use these drugsmore safely and effectively. This review identifies the knowledge gaps and future trials needed to address those issues with the use of APAs in CKD patients.",
author = "Nishank Jain and {Susan Hedayati}, S. and Ravindra Sarode and Subhash Banerjee and Reilly, {Robert F.}",
year = "2013",
month = "4",
day = "5",
doi = "10.2215/CJN.06790712",
language = "English (US)",
volume = "8",
pages = "665--674",
journal = "Clinical Journal of the American Society of Nephrology",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "4",

}

TY - JOUR

T1 - Antiplatelet therapy in the management of cardiovascular disease in patients with CKD

T2 - What is the evidence?

AU - Jain, Nishank

AU - Susan Hedayati, S.

AU - Sarode, Ravindra

AU - Banerjee, Subhash

AU - Reilly, Robert F.

PY - 2013/4/5

Y1 - 2013/4/5

N2 - Antiplatelet agents (APAs) are proven to reduce risk of major cardiovascular events in patientswith cardiovascular disease and normal kidney function. With recent post hoc analyses of large trials questioning the safety and efficacy of APAs in CKD, major gaps exist in our understanding of platelet aggregability and the effects of APAs on thrombosis and bleeding in CKD. Clinical practice guidelines are ambiguous about use of such agents in CKD patients, because patients with moderate to advanced CKD were systematically excluded from clinical trials of APAs. CKD patients experience excessive rates of cardiovascular thrombotic events, yet paradoxically are at higher risk formajor bleedingwhile receiving APAs. Furthermore, observational studies suggest that CKDpatients may exhibit poor response to APAs. High residual platelet aggregability, as determined by inhibition of platelet aggregation, is associated with increased risk for cardiovascular events. In addition, metabolism of certain APAs may be altered in CKD patients. It is, therefore, imperative to explore the mechanisms responsible for poor response to APAs in CKD patients in order to use these drugsmore safely and effectively. This review identifies the knowledge gaps and future trials needed to address those issues with the use of APAs in CKD patients.

AB - Antiplatelet agents (APAs) are proven to reduce risk of major cardiovascular events in patientswith cardiovascular disease and normal kidney function. With recent post hoc analyses of large trials questioning the safety and efficacy of APAs in CKD, major gaps exist in our understanding of platelet aggregability and the effects of APAs on thrombosis and bleeding in CKD. Clinical practice guidelines are ambiguous about use of such agents in CKD patients, because patients with moderate to advanced CKD were systematically excluded from clinical trials of APAs. CKD patients experience excessive rates of cardiovascular thrombotic events, yet paradoxically are at higher risk formajor bleedingwhile receiving APAs. Furthermore, observational studies suggest that CKDpatients may exhibit poor response to APAs. High residual platelet aggregability, as determined by inhibition of platelet aggregation, is associated with increased risk for cardiovascular events. In addition, metabolism of certain APAs may be altered in CKD patients. It is, therefore, imperative to explore the mechanisms responsible for poor response to APAs in CKD patients in order to use these drugsmore safely and effectively. This review identifies the knowledge gaps and future trials needed to address those issues with the use of APAs in CKD patients.

UR - http://www.scopus.com/inward/record.url?scp=84878913798&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878913798&partnerID=8YFLogxK

U2 - 10.2215/CJN.06790712

DO - 10.2215/CJN.06790712

M3 - Article

C2 - 23024160

AN - SCOPUS:84878913798

VL - 8

SP - 665

EP - 674

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

IS - 4

ER -