Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, No. 2, Anzhen Street, Chaoyang District, Beijing, China.
Division of Nephrology, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, No.382, Wuyi Road, Xinghualing Distirct, Taiyuan, China.
BMC Nephrol. 2019 Aug 7;20(1):309. doi: 10.1186/s12882-019-1499-3.
The benefits and risks of antiplatelet therapy for patients with chronic kidney disease (CKD) remain controversial. We undertook a systematic review and meta-analysis to investigate the effects of antiplatelet therapy on major clinical outcomes.
We systematically searched MEDLINE, Embase, and the Cochrane Library for trials published before April 2019 without language restriction. We included rrandomized controlled trials that involved adults with CKD and compared antiplatelet agents with controls.
Fifty eligible trials that included at least one event were identified, providing data for 27773patients with CKD, including 4518 major cardiovascular events and 1962 all-cause deaths. Antiplatelet therapy produced a 15% (OR, 0.85; 95% CI 0.74-0.94) reduction in the odds of major cardiovascular events (P = 0.002), a 48% reduction for access failure events (OR, 0.52; 95% CI, 0.31-0.73), but had no significantly effect on all-cause death (OR, 0.87; 95% CI, 0.71-1.01) or kidney failure events (OR, 0.87; 95% CI, 0.32-1.55). Adverse events were significantly increased by antiplatelet therapy, including major (OR, 1.33; 95% CI, 1.11-1.59) or minor bleeding (OR, 1.66; 95% CI, 1.27-2.05). Among every 1000 persons with CKD treated with antiplatelet therapy for 12 months, 23 major cardiovascular events will be prevented while nine major bleeding events will occur.
Major prevention with antiplatelet agents (cardiovascular events and access failure), might outweigh the risk of bleeding, and there seemed to be an overall net benefit. Individual evaluation and careful monitoring are required.
抗血小板治疗在慢性肾脏病（CKD）患者中的获益和风险仍存在争议。我们进行了一项系统评价和荟萃分析，以研究抗血小板治疗对主要临床结局的影响。
我们系统地检索了 MEDLINE、Embase 和 Cochrane 图书馆，检索时间截至 2019 年 4 月，无语言限制。我们纳入了涉及 CKD 成年患者的随机对照试验，并将抗血小板药物与对照组进行了比较。
共确定了 50 项符合条件的试验，这些试验共纳入了 27773 例 CKD 患者，包括 4518 例主要心血管事件和 1962 例全因死亡。抗血小板治疗可使主要心血管事件的风险降低 15%（OR，0.85；95%CI，0.74-0.94）（P=0.002），降低通路失败事件的风险 48%（OR，0.52；95%CI，0.31-0.73），但对全因死亡（OR，0.87；95%CI，0.71-1.01）或肾功能衰竭事件（OR，0.87；95%CI，0.32-1.55）无显著影响。抗血小板治疗显著增加了不良事件，包括主要（OR，1.33；95%CI，1.11-1.59）或轻微出血（OR，1.66；95%CI，1.27-2.05）。在每 1000 例接受抗血小板治疗 12 个月的 CKD 患者中，将预防 23 例主要心血管事件，同时发生 9 例主要出血事件。
抗血小板药物（心血管事件和通路失败）的主要预防作用可能超过出血风险，且总体上似乎存在净获益。需要进行个体评估和仔细监测。
