Study Finds Bleeding Risks of Plavix, Other Antibleeding Therapies, May Outweigh Benefits in Chronic Kidney Disease Patients

Anti-bleeding drugs such as Plavix may do more harm than good in patients with chronic kidney disease, according to a study published this month in the March 20 issue of the Annals of Internal Medicine. According to the study, the results showed that antiplatelet therapy plus standard care increased major and minor bleeding in these patients.

According to the authors of the study, people with chronic kidney disease have a 25 percent to 30 percent increased risk of developing cardiovascular disease. The risk can increase to 50-fold or higher in patients with end-stage kidney disease. Often, patients with chronic kidney disease are prescribed antiplatelet therapy, such as Plavix, to prevent heart disease, though these patients may have a higher risk of bleeding with these drugs.

To better understand the impact of antiplatelet treatments on chronic kidney disease patients, Suetonia C. Palmer, MB, PhD, of the University of Otago Christchurch in Christchurch, New Zealand, and colleagues looked at nine trials involving 9,969 patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) and 31 trials involving 11,701 patients with stable and no cardiovascular disease. The research team then compared rates of cardiovascular events, mortality and bleeding among those on antiplatelet therapy to patients who received standard care, placebo or no treatment.

An analysis of the nine trials involving patients with PCI showed that antiplatelet therapy plus standard care increased major and minor bleeding. “Antiplatelet therapy increased major bleeding in analyses limited to trials reporting outcomes at one year or more,” the authors wrote.

Of the trials analyzed, 18 reported major bleeding events and eight reported minor bleeding events.

According to the article, the study found only “low-quality” evidence that antiplatelet treatment on top of standard care had “little or no effect on myocardial infarction (seven trials, 5,261 participants), with no evidence of significant heterogeneity.” Adding antiplatelet therapy to standard therapy also had little or no effect on all-cause mortality during the analysis, and effects on cardiovascular mortality were uncertain.

No trials focused on reporting the details of hemorrhagic stroke. One trial included in the analysis showed that six strokes, fatal or nonfatal, occurred in 411 patients, alluding to the fact that Plavix as an add-on to standard therapy had “uncertain” effect on stroke, they wrote.

“Bleeding hazards and lack of clear efficacy in reducing cardiovascular morbidity and mortality need to be acknowledged when patients with CKD (chronic kidney disease) are being counseled about acute or long-term antiplatelet therapy,” the authors wrote. They called for more studies designed to evaluate the risks and benefits of administering antiplatelet to therapies in these patients.

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