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Efficacy of Antiplatelet Agent Usage for Primary and Secondary Prevention in Dialysis Patients: a Nationwide Data Survey and Propensity Analysis

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Abstract

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.

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Funding

This study was financially supported by Taiwan’s Ministry of Science and Technology (MOST 103-2220-E-002 -011). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There are no relationships with industry. No conflict of interest exists in this study.

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Author notes

  1. Yen-Hung Lin and Lian-Yu Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan

    Zheng-Wei Chen, Cho-Kai Wu, Jenq-Wen Huang, Vin-Cent Wu, Jen-Kuang Lee, Yen-Hung Lin & Lian-Yu Lin

  2. Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan

    Zheng-Wei Chen

  3. Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chia-Yi, Taiwan

    Yao-Hsu Yang

  4. Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan

    Yao-Hsu Yang & Pau-Chung Chen

Authors
  1. Zheng-Wei Chen
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  2. Cho-Kai Wu
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  8. Yen-Hung Lin
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  9. Lian-Yu Lin
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Corresponding authors

Correspondence to Yen-Hung Lin or Lian-Yu Lin.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the current study were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The data of this study was obtained from the Taiwan National Health Insurance research database. Informed consent from individual patients was not required.

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Chen, ZW., Wu, CK., Yang, YH. et al. Efficacy of Antiplatelet Agent Usage for Primary and Secondary Prevention in Dialysis Patients: a Nationwide Data Survey and Propensity Analysis. Cardiovasc Drugs Ther 33, 471–479 (2019). https://doi.org/10.1007/s10557-019-06882-0

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  • DOI: https://doi.org/10.1007/s10557-019-06882-0

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