For these interventions, data were entirely based Rucaparib purchase on post-hoc analysis for the subgroup with chronic kidney disease derived from larger trials. The remaining trials examined oral antiplatelet therapy in people who have chronic kidney disease (aspirin, thienopyridines or dipyridamole, defibrotide, picotamide, or sulfinpyrazone alone or in combination) and who were at risk of or who had stable cardiovascular disease. Overall, 19 studies (16 065 participants) included people who had chronic kidney disease stage 3–5, three studies (137 participants) enrolled recipients of a kidney transplant and 21 studies (4820 participants)

were in people with chronic kidney disease stage 5D. Trial sample sizes (62–4087 participants; median 100 participants) were highly variable and follow up was continued on average for 9 months (range 1–61 months). Overall, there were limitations in study design that may have affected the reliability of results. These limitations were present in more than half of trials, and included concerns as to whether investigators

were unaware of treatment allocation, adequate follow up occurred in all participants, and all relevant outcomes were measured and reported. In people who had chronic kidney disease and acute coronary syndromes or were undergoing percutaneous STI571 manufacturer coronary intervention, glycoprotein IIb/IIIa inhibitors had little or no effect on myocardial infarction, uncertain effects on total and cardiovascular mortality and stroke, but increased major bleeding. In people who had chronic kidney disease and were at risk of, or who had stable cardiovascular disease, antiplatelet therapy prevented myocardial infarction but had imprecise effects on total cardiovascular mortality, stroke and major bleeding. Whether the benefits and harms of antiplatelet therapy are

different based on stage of kidney find more disease and whether antiplatelet agents are effective for primary prevention of cardiovascular events in the setting of chronic kidney disease remain uncertain. Antiplatelet agents are widely used to prevent cardiovascular events in the general population. In people who have chronic kidney disease, occlusive atherosclerosis is a less common mechanism for major cardiovascular events and the bleeding risks may be higher than in the general population. Based on this review, major bleeding complications are an important factor to consider when making clinical decisions about prescribing glycoprotein IIb/IIIa inhibitors in people who have chronic kidney disease and acute coronary syndromes or who are undergoing percutaneous coronary interventions. This is particularly true given the lack of evidence for reduced mortality and cardiovascular events when using antiplatelet agents. Overall, benefits of antiplatelet therapy are limited to preventing myocardial infarction in people with chronic kidney disease with or without cardiovascular disease.