1007 Antithrombotics in Renal and Mesenteric Arterial Disease: A Systematic Review
R Mercer, H Ahmed, K Wong, R Hinchliffe, C Twine- Surgery
Abstract
Aim
This systematic review aims to pool the literature on antithrombotic therapy for patients with renal or mesenteric arterial disease.
Method
Medline, EMBASE, Cochrane library, and the ICTRP were searched for studies comparing outcomes in atherosclerotic renal or mesenteric arterial disease for patients using antithrombotic therapy. Primary outcomes included major adverse cardiovascular events, major bleeding, and mortality.
Results
Seventeen full texts were included for narrative synthesis (2427 patients). Five studies assessed antithrombotic use for atherosclerotic renal disease. One retrospective cohort study (serious risk of bias) found antiplatelets (62 patients) reduced all-cause mortality compared to those not receiving antiplatelets (162 patients) for renal arterial disease (P = 0.01). One study (77 patients) reported no significant differences in risk of renal artery restenosis between aspirin or clopidogrel (P = 0.052), the second study (28 patients) reported aspirin was associated with increased eGFR post intervention (P = 0.006) (both high risk of bias). One randomised control trial (some concerns for bias, 100 patients) found that those receiving both abciximab platelet inhibition and embolic protection devices had reduced platelet-rich thrombi compared to those on either therapy alone (P<0.01). Bleeding rates were similar between all patient groups. Twelve cohort studies (serious risk of bias) assessed antithrombotic use for mesenteric disease. Results were mixed between a reduction (3 studies) or no reduction (9 studies) in all-cause mortality.
Conclusions
Disease-specific data supporting the use of antithrombotic therapy in renal and mesenteric disease are of low-quality. High-quality data (randomised or registry) is necessary to further support current treatment recommendations.