Renal Safety of Aspirin Versus Aspirin–Clopidogrel Therapy After Myocardial Infarction

Abstract

Antiplatelet treatment is an essential part of secondary prevention following a myocardial infarction where aspirin and aspirin-clopidogrel dual therapy have become common to curb repeat attacks as well as cardiovascular deaths. Although the cardiovascular effects of these regimens are now well-known, their safety on the kidneys is a significant clinical issue, especially in patients with a pre-existing renal susceptibility. Myocardial infarction is commonly followed by hemodynamic instability, inflammation and neurohormonal activation that can put patients at risk of renal dysfunction. In that regard, antiplatelet therapy can impact the renal outcomes either directly or indirectly, particularly, bleeding-related complications. This narrative review presents the existing evidence on the harmfulness of aspirin monotherapy over aspirin-clopidogrel therapy in the aftermath of myocardial infarction. Available evidence indicates that low doses of aspirin are better tolerated renal wise when administered at the right time even in chronic kidney disease patients. Conversely, dual antiplatelet therapy has a higher level of ischemic protection, but has a higher likelihood of bleeding, potentially leading to acute renal failure and the aggravation of renal disease in vulnerable groups. The determinants of renal outcomes are strongly dependent on the initial kidney function, age and burden comorbidity, the duration of treatment, and the factors of the procedure like percutaneous coronary intervention. On the whole, this review highlights that consideration of renal safety in the decision-making of the antiplatelet treatment is essential and that patients should receive tailored therapy, active renal follow-up, and multidisciplinary care to maximize the cardiovascular outcome and reduce renal risk following the occurrence of myocardial infarction.