Background: Although cardiovascular (CV) disease is the leading cause of mortality and morbidity in dialysis patients, there is little evidence to guide the use of antiplatelet agents in dialysis patients.
Method: A nationwide database (Registry for Catastrophic Illnesses) for Taiwan, which has data from nearly all patients who received dialysis therapy from 1995 to 2008, was used. This is a population-based cohort study with time to event analyses to estimate the relation between antiplatelet agent use and outcomes. Hazard ratios were calculated to evaluate the effect of antiplatelet agent use on the risk of major CV events and mortality. Baseline characteristics were matched by propensity score (PS).
Results: A total of 71,835 were included, and 10,595 (14.7%) patients received an anti-platelet agent. The median value of follow-up days was 61.6 months. After PS-based matching, 9598 patients who used an antiplatelet agent and 23,794 non-users were included in the analysis. After PS matching, there was no difference between patients using an antiplatelet agent or not in CV events (p = 0.672) and total mortality (p = 0.529). A subgroup analysis of different usage periods of antiplatelet agents indicated that CV events and total mortality were similar in those who used antiplatelet agents for short or long durations. In subgroup analysis, there was also no difference between patients with a different modality of dialysis (hemodialysis or peritoneal dialysis), different antiplatelet agents (aspirin, clopidogrel, and/or ticlopidine) or patients with/without previous cardiovascular disease in CV events and total mortality.
Conclusions: Antiplatelet agent usage does not reduce CV events and total mortality in dialysis patients.
Keywords: Antiplatelet; Aspirin; Clopidogrel; Dialysis; Propensity score; Ticlopidine.