Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease
Authors: Giovanni F.M. Strippoli, Suetonia C. Palmer, Jonathan C. Craig
Journal: Annals of Internal Medicine (2012)

Letters21 August 2012Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney DiseaseGiovanni F.M. Strippoli, MD, PhD, MPH, MM, Suetonia C. Palmer, MBChB, PhD, and Jonathan C. Craig, MBChB, DCh, MM, PhDGiovanni F.M. Strippoli, MD, PhD, MPH, MMFrom Consorzio Mario Negri Sud, 66030 Santa Maria Imbaro, Italy; University of Otago Christchurch, Christchurch 8140, New Zealand; and University of Sydney School of Public Health, New South Wales 2006, Australia.Search for more papers by this author, Suetonia C. Palmer, MBChB, PhDFrom Consorzio Mario Negri Sud, 66030 Santa Maria Imbaro, Italy; University of Otago Christchurch, Christchurch 8140, New Zealand; and University of Sydney School of Public Health, New South Wales 2006, Australia.Search for more papers by this author, and Jonathan C. Craig, MBChB, DCh, MM, PhDFrom Consorzio Mario Negri Sud, 66030 Santa Maria Imbaro, Italy; University of Otago Christchurch, Christchurch 8140, New Zealand; and University of Sydney School of Public Health, New South Wales 2006, Australia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-4-201208210-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Kussmaul raises an important point: Does evidence from a randomized, controlled trial (RCT) tell us whether patients with CKD should receive aspirin and clopidogrel for 12 months after coronary artery stenting? In the general population, guidelines recommend antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) for 12 months after percutaneous stent insertion, unless the risk for morbidity from bleeding outweighs the anticipated benefits, in which earlier discontinuation from the P2Y12 inhibitor is reasonable (1). Applying the evidence from the general population to patients with CKD may be inappropriate because of the increased risk ...References1. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124:2574-609. [PMID: 22064598] CrossrefMedlineGoogle Scholar2. Best PJ, Steinhubl SR, Berger PB, Dasgupta A, Brennan DM, Szczech LA, et al; CREDO Investigators. The efficacy and safety of short- and long-term dual antiplatelet therapy in patients with mild or moderate chronic kidney disease: results from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial. Am Heart J. 2008;155:687-93. [PMID: 18371477] CrossrefMedlineGoogle Scholar3. Keltai M, Tonelli M, Mann JF, Sitkei E, Lewis BS, Hawken S, et al; CURE Trial Investigators. Renal function and outcomes in acute coronary syndrome: impact of clopidogrel. Eur J Cardiovasc Prev Rehabil. 2007;14:312-8. [PMID: 17446813] CrossrefMedlineGoogle Scholar4. Jardine MJ, Ninomiya T, Perkovic V, Cass A, Turnbull F, Gallagher MP, et al. Aspirin is beneficial in hypertensive patients with chronic kidney disease: a post-hoc subgroup analysis of a randomized controlled trial. J Am Coll Cardiol. 2010;56:956-65. [PMID: 20828648] CrossrefMedlineGoogle Scholar5. Sun X, Briel M, Busse JW, You JJ, Akl EA, Mejza F, et al. Credibility of claims of subgroup effects in randomised controlled trials: systematic review. BMJ. 2012;344:1553. [PMID: 22422832] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Consorzio Mario Negri Sud, 66030 Santa Maria Imbaro, Italy; University of Otago Christchurch, Christchurch 8140, New Zealand; and University of Sydney School of Public Health, New South Wales 2006, Australia.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2512. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease Suetonia C. Palmer , Lucia Di Micco , Mona Razavian , Jonathan C. Craig , Vlado Perkovic , Fabio Pellegrini , Massimiliano Copetti , Giusi Graziano , Gianni Tognoni , Meg Jardine , Angela Webster , Antonio Nicolucci , Sophia Zoungas , and Giovanni F.M. Strippoli Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease William Kussmaul Effects of Antiplatelet Therapy on Mortality and Cardiovascular and Bleeding Outcomes in Persons With Chronic Kidney Disease R. Brooks Robey and Daniel J. O'Rourke Metrics 21 August 2012Volume 157, Issue 4Page: 303-304KeywordsAntiplatelet therapyHemorrhageHypertensionMorbidityMyocardial infarctionStent implantationSystematic reviews ePublished: 21 August 2012 Issue Published: 21 August 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...