Clinical Question

Does antiplatelet therapy prevent myocardial infarction in patients with chronic kidney disease (CKD)?

Evidence-Based Answer

Antiplatelet therapy reduces the risk of myocardial infarction by 0.8% compared with placebo (95% CI, 0.1% to 1.5%; number needed to treat [NNT] = 125) in patients with CKD but is associated with an increased risk of major bleeding (number needed to harm [NNH] = 100).¹ (Strength of Recommendation: C, disease-oriented evidence.)

Practice Pointers

Conditions that increase the risk of CKD, including hypertension, obesity, and diabetes mellitus, are increasing worldwide with a commensurate increase in the global health care expense related to these conditions. Myocardial infarction is three times more likely in patients with CKD compared with those who have normal kidney function. In general, cardiovascular disease is the leading cause of morbidity and mortality in patients with CKD.^2,3 Excessive platelet activation in CKD is postulated to create a prothrombotic state and antiplatelet agents have been extensively used in these patients.⁴ The authors of this analysis sought to discern the effectiveness of antiplatelet agents in preventing myocardial infarction.