Thomas A Mavrakanas1,2, Yiannis S Chatzizisis3, Karim Gariani4, Dean J Kereiakes5, Giuseppe Gargiulo6,7, Gérard Helft8, Martine Gilard9, Fausto Feres10, Ricardo A Costa10, Marie-Claude Morice11, Jean-Louis Georges12, Marco Valgimigli6, Deepak L Bhatt13, Laura Mauri14, David M Charytan15,16,17. 1. Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; tmavrakanas@gmail.com. 2. Department of Medicine, Geneva University Hospitals, Geneva, Switzerland. 3. Cardiovascular Division, University of Nebraska Medical Center, Omaha, Nebraska. 4. Division of Diabetes and Endocrinology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 5. The Christ Hospital Heart and Vascular Center and The Lindner Center for Research and Education, Cincinnati, Ohio. 6. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. 7. Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy. 8. Institute of Cardiology, University Hospitals Pitié-Salpêtrière- Charles Foix (Public Assistance- Hospitals of Paris), Sorbonne University, Paris, France. 9. Division of Cardiology, Regional University Hospital La Cavale Blanche, Brest, France. 10. Institute Dante Pazzanese de Cardiologia, Sao Paulo, Sao Paulo, Brazil. 11. Private Hospital Jacques Cartier, Ramsay Générale de Santé, Massy, France. 12. Hospital of Versailles, Le Chesnay, France. 13. Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. 14. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 15. Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 16. Baim Institute for Clinical Research, Boston, Massachusetts; and. 17. Division of Nephrology, New York University Langone Medical Center, New York, New York.
Abstract
BACKGROUND AND OBJECTIVES: Whether prolonged dual antiplatelet therapy (DAPT) is more protective in patients with CKD and drug-eluting stents compared with shorter DAPT is uncertain. The purpose of this meta-analysis was to examine whether shorter DAPT in patients with drug-eluting stents and CKD is associated with lower mortality or major adverse cardiovascular event rates compared with longer DAPT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A Medline literature research was conducted to identify randomized trials in patients with drug-eluting stents comparing different DAPT duration strategies. Inclusion of patients with CKD was also required. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or stent thrombosis (definite or probable). Major bleeding was the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. RESULTS: Five randomized trials were included (1902 patients with CKD). Short DAPT (≤6 months) was associated with a similar incidence of the primary outcome, compared with 12-month DAPT among patients with CKD (48 versus 50 events; RR, 0.93; 95% confidence interval [95% CI], 0.64 to 1.36; P=0.72). Twelve-month DAPT was also associated with a similar incidence of the primary outcome compared with extended DAPT (≥30 months) in the CKD subgroup (35 versus 35 events; RR, 1.04; 95% CI, 0.67 to 1.62; P=0.87). Numerically lower major bleeding event rates were detected with shorter versus 12-month DAPT (9 versus 13 events; RR, 0.69; 95% CI, 0.30 to 1.60; P=0.39) and 12-month versus extended DAPT (9 versus 12 events; RR, 0.83; 95% CI, 0.35 to 1.93; P=0.66) in patients with CKD. CONCLUSIONS: Short DAPT does not appear to be inferior to longer DAPT in patients with CKD and drug-eluting stents. Because of imprecision in estimates (few events and wide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.
BACKGROUND AND OBJECTIVES: Whether prolonged dual antiplatelet therapy (DAPT) is more protective in patients with CKD and drug-eluting stents compared with shorter DAPT is uncertain. The purpose of this meta-analysis was to examine whether shorter DAPT in patients with drug-eluting stents and CKD is associated with lower mortality or major adverse cardiovascular event rates compared with longer DAPT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A Medline literature research was conducted to identify randomized trials in patients with drug-eluting stents comparing different DAPT duration strategies. Inclusion of patients with CKD was also required. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or stent thrombosis (definite or probable). Major bleeding was the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. RESULTS: Five randomized trials were included (1902 patients with CKD). Short DAPT (≤6 months) was associated with a similar incidence of the primary outcome, compared with 12-month DAPT among patients with CKD (48 versus 50 events; RR, 0.93; 95% confidence interval [95% CI], 0.64 to 1.36; P=0.72). Twelve-month DAPT was also associated with a similar incidence of the primary outcome compared with extended DAPT (≥30 months) in the CKD subgroup (35 versus 35 events; RR, 1.04; 95% CI, 0.67 to 1.62; P=0.87). Numerically lower major bleeding event rates were detected with shorter versus 12-month DAPT (9 versus 13 events; RR, 0.69; 95% CI, 0.30 to 1.60; P=0.39) and 12-month versus extended DAPT (9 versus 12 events; RR, 0.83; 95% CI, 0.35 to 1.93; P=0.66) in patients with CKD. CONCLUSIONS: Short DAPT does not appear to be inferior to longer DAPT in patients with CKD and drug-eluting stents. Because of imprecision in estimates (few events and wide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.
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