***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Type 2 diabetes accompanied by renal damage is a strong risk factor for atherosclerotic events . The purpose of this study was to investigate the efficacy of low-dose aspirin therapy on primary prevention of atherosclerotic events in patients with type 2 diabetes and coexisting renal dysfunction . RESEARCH DESIGN AND METHODS The Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes ( JPAD ) trial was a prospect i ve , r and omized , open-label trial conducted throughout Japan that enrolled 2,539 type 2 diabetic patients without a history of atherosclerotic diseases . Patients were assigned to the aspirin group ( 81 mg/day or 100 mg/day ) or the nonaspirin group and followed for a median of 4.37 years . The primary end points were atherosclerotic events of fatal and nonfatal ischemic heart disease , stroke , and peripheral arterial disease . RESULTS The analysis included 2,523 patients who had serum creatinine measured . In 1,373 patients with baseline estimated glomerular filtration rate ( eGFR ) 60–89 mL/min/1.73 m2 , the incidence of primary end points was significantly lower in the aspirin group than in the nonaspirin group ( aspirin , 30/661 ; nonaspirin , 55/712 ; hazard ratio 0.57 [ 95 % CI 0.36–0.88 ] ; P = 0.011 ) . Low-dose aspirin therapy did not reduce primary end points in patients with eGFR ≥90 mL/min/1.73 m2 ( aspirin , 9/248 ; nonaspirin , 11/270 ; 0.94 [ 0.38–2.3 ] ) or those with eGFR < 60 mL/min/1.73 m2 ( aspirin , 29/342 ; nonaspirin , 19/290 ; 1.3 [ 0.76–2.4 ] ) . The Cox proportional hazard model demonstrated a significant interaction between mild renal dysfunction ( eGFR 60–89 mL/min/1.73 m2 ) and aspirin ( P = 0.02 ) . CONCLUSIONS These results suggest a differential effect of low-dose aspirin therapy in diabetic patients with eGFR 60–89 mL/min/1.73 m2 Background —The role of glycoprotein IIb/IIIa receptor antagonists for the treatment of patients with acute coronary syndrome and renal insufficiency remains undefined . Methods and Results — Patients from the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms ( PRISM-PLUS ) trial were stratified by creatinine clearance ( CrCl ) and assessed with respect to treatment assignment to tirofiban/heparin versus heparin alone for the risk of adverse outcomes and bleeding . Patients with severe renal insufficiency ( defined as a serum creatinine ≥2.5 mg/dL ) were excluded from PRISM-PLUS as a whole . Patients with the lowest CrCl ( < 30 mL/min ) were more likely to present with high-risk clinical features . Decreasing renal function was strongly associated with adverse outcome , increasing the risk for ischemic complications at all time points examined ( all P < 0.002 ) . Irrespective of CrCl , therapy with tirofiban reduced the odds of the composite end point of death , myocardial infa rct ion , or refractory ischemia at 48 hours ( odds ratio [ OR ] , 0.68 ; 95 % confidence interval [ CI ] , 0.46 to 1.0;P = 0.05 ) , 7 days ( OR , 0.68 ; 95 % CI , 0.52 to 0.88;P = 0.003 ) , 30 days ( OR , 0.78 ; 95 % CI , 0.63 to 0.98;P = 0.03 ) , and 6 months ( OR , 0.81 ; 95 % CI , 0.68 to 0.98;P = 0.03 ) . The risk of myocardial infa rct ion/death was also significantly decreased to a similar magnitude at all time points examined . There was no evidence of treatment-by-CrCl interaction . The presence of declining renal function independently increased the risk for bleeding ( OR , 1.57;P < 0.001 for trend across categories ) , as did therapy with tirofiban , but no unexpected incremental risk of bleeding due to tirofiban was observed among lowest CrCl categories . Conclusions —Among patients with mild-to-moderate renal insufficiency in PRISM-PLUS , tirofiban was well tolerated and effective in reducing ischemic acute coronary syndrome complications Idiopathic membranoproliferative glomerulonephritis ( MPGN ) has a poor prognosis , with 90 % of patients requiring dialysis treatment after 20 years regardless of therapy . Up to 34 % of patients may die due to thrombotic complications or sepsis . This study investigates the influence of aspirin plus dipyridamole on proteinuria and renal function in nephrotic MPGN patients with moderately reduced glomerular filtration rate . Eighteen patients with biopsy-proven MPGN ( 15 type I , 3 type II ) and nephrotic syndrome were r and omly assigned to receive protein restriction , antihypertensive therapy ( control group ) or in addition aspirin and dipyridamole ( treatment group ) . Patients were prospect ively followed for a mean of 36 months . Serum creatinine remained unchanged after 36 months compared to baseline in both groups . In the treatment group proteinuria was reduced from 8.3 + /- 1.4 to 1.6 + /- 0.7 g/day ( P < 0.05 ) . In control patients proteinuria decreased from 7.1 + /- 1.6 to 4.3 + /- 1.1 g/day . After 36 months proteinuria was significantly lower in the treatment group compared to control ( P < 0.02 Mann-Whitney rank sum test ) . In conclusion , aspirin plus dipyridamole may be of value in reversing nephrotic syndrome and associated risks in patients with MPGN and moderately reduced renal function Since platelet cyclo-oxygenase is much more sensitive to inactivation by aspirin than is the enzyme in the arterial wall and low doses of aspirin may prevent thrombosis by blocking thromboxane synthesis , we conducted a r and omized , double-blind trial of aspirin ( 160 mg per day ) vs. placebo in 44 patients on chronic hemodialysis . The study was continued until there were 24 patients with thrombi and both groups had been under observation for a mean of nearly five months . Thrombi occurred in 18 of 25 ( 72 per cent ) of patients given placebo and 16 of 19 ( 32 per cent ) of those given aspirin ( P less than 0.01 ) . The incidence of thrombosis was reduced from 0.46 thrombi per patient month in the placebo group to 0.16 thrombi per patient month in the aspirin group ( p less than 0.005 ) . A dose of 160 mg of aspirin per day is an effective , nontoxic antithrombotic regimen in patients on hemodialysis Background — Reduced renal function is associated with a poorer prognosis and increased bleeding risk in patients with acute coronary syndromes and may therefore alter the risk-benefit ratio with antiplatelet therapies . In the Platelet Inhibition and Patient Outcomes ( PLATO ) trial , ticagrelor compared with clopidogrel reduced the primary composite end point of cardiovascular death , myocardial infa rct ion , and stroke at 12 months but with similar major bleeding rates . Methods and Results — Central laboratory serum creatinine levels were available in 15 202 ( 81.9 % ) acute coronary syndrome patients at baseline , and creatinine clearance , estimated by the Cockcroft Gault equation , was calculated . In patients with chronic kidney disease ( creatinine clearance < 60 mL/min ; n=3237 ) , ticagrelor versus clopidogrel significantly reduced the primary end point to 17.3 % from 22.0 % ( hazard ratio [ HR ] , 0.77 ; 95 % confidence interval [ CI ] , 0.65 to 0.90 ) with an absolute risk reduction greater than that of patients with normal renal function ( n=11 965 ) : 7.9 % versus 8.9 % ( HR , 0.90 ; 95 % CI , 0.79 to 1.02 ) . In patients with chronic kidney disease , ticagrelor reduced total mortality ( 10.0 % versus 14.0 % ; HR , 0.72 ; 95 % CI , 0.58 to 0.89 ) . Major bleeding rates , fatal bleedings , and non – coronary bypass – related major bleedings were not significantly different between the 2 r and omized groups ( 15.1 % versus 14.3 % ; HR , 1.07 ; 95 % CI , 0.88 to 1.30 ; 0.34 % versus 0.77 % ; HR , 0.48 ; 95 % CI , 0.15 to 1.54 ; and 8.5 % versus 7.3 % ; HR , 1.28 ; 95 % CI , 0.97 to 1.68 ) . The interactions between creatinine clearance and r and omized treatment on any of the outcome variables were nonsignificant . Conclusions — In acute coronary syndrome patients with chronic kidney disease , ticagrelor compared with clopidogrel significantly reduces ischemic end points and mortality without a significant increase in major bleeding but with numerically more non – procedure-related bleeding . Clinical Trial Registration — URL : http://www.clinicatrials.gov . Unique identifier : NCT00391872 When constructing arteriovenous fistulas for haemodialysis in chronic renal failure patients , one of the main problems is still their clotting tendency . Ticlopidine is an effective inhibitor of platelet aggregation . In this r and omized double-blind study placebo or ticlopidine 250 mg twice daily was given to chronic uremic patients up to 4 weeks after construction of an arteriovenous fistula . 42 patients were recruited and 36 completed the trial . The fistula clotted in 8 patients on placebo and in 2 patients on ticlopidine . The difference is significant . This effect was achieved without an increased frequency of side effects compared with placebo . It is concluded that ticlopidine has a function as a thromboprophylactic drug in chronic uremic patients The optimal vascular access for chronic maintenance hemodialysis is the arteriovenous fistula ( AVF ) . Several studies suggest a role for antiplatelet agents in the prevention of primary AVF failure . A double-blind , r and omized trial was conducted to assess the efficacy and safety of clopidogrel in hemodialysis patients . Ninety three patients were r and omized to receive 75 mg/daily of clopidogrel or placebo .  The treatment was initiated 7–10 days prior to scheduled access surgery and continued up to six weeks postoperatively , and then patients were monitored for six months . The primary outcome was AVF failure eight weeks after fistula creation . With a permuted block r and omization schedule , 46 patients received clopidogrel and 47 patients received control placebo .  The primary AVF failures at two months were 21.6 % in placebo group and 5.2 % in clopidogrel group ( P = 0.03 ) . The hazard ratio for the incidence of primary AVF failure was 0.72 ( CI 95 % , 0.41–1.01 ) . Analysis of covariables indicated that this effect occurred principally as a result of clopidogrel administration . First hemodialysis from newly created AVF in clopidogrel group was significantly more successful than placebo group ( P = 0.008 ) . No life-threatening adverse event or severe bleeding was recorded in both groups . Clopidogrel seems to be effective and safe for prevention of primary AVF failure in hemodialysis patients In a prospect i ve r and omized trial the anti-thrombotic effect of dipyridamole was studied in 64 patients after cadaveric kidney allotransplantation . The frequency of early graft function was significantly higher in the control group , whereas the incidence of arterial and venous thromboses were not different . One-year graft survival could not be improved by dipyridamole . Therefore , dipyridamole should not be recommended in cadaveric kidney allotransplantation BACKGROUND Mild and moderate chronic kidney disease ( CKD ) is associated with decreased survival and increased adverse events after a percutaneous coronary intervention ( PCI ) . Therapy with clopidogrel decreases adverse events in large patient population s. Therefore , we sought to determine the efficacy and safety of long-term clopidogrel therapy in patients with CKD . METHODS Two thous and two patients from the CREDO trial in whom an elective PCI of a single or multiple vessels was planned were analyzed . Patients were r and omly assigned to a 300-mg loading dose of clopidogrel before PCI followed by clopid 
    Output:
    
Low- quality evidence has found that in persons with acute coronary syndromes , glycoprotein IIb/IIIa inhibitors or clopidogrel plus st and ard care compared with st and ard care alone had little or no effect on all-cause or cardiovascular mortality or on myocardial infa rct ion but increased serious bleeding .
Benefits for antiplatelet therapy among persons with CKD are uncertain and are potentially outweighed by bleeding hazards .