Duration of dual antiplatelet therapy in patients with CKD and drug-eluting stents: A meta-analysis

Thomas A. Mavrakanas, Yiannis S. Chatzizisis, Karim Gariani, Dean J. Kereiakes, Giuseppe Gargiulo, Gérard Helft, Martine Gilard, Fausto Feres, Ricardo A. Costa, Marie Claude Morice, Jean Louis Georges, Marco Valgimigli, Deepak L. Bhatt, Laura Mauri, David M. Charytan

Research output: Contribution to journalArticle

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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 patientswith drug-eluting stents comparing differentDAPTduration 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 bleedingwas the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. Results Five randomized trials were included (1902 patientswith CKD). Short DAPT (≤6months)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 associatedwith a similar incidence of theprimary outcome comparedwithextendedDAPT(≥30months) 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 (fewevents andwide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.

Original languageEnglish (US)
Pages (from-to)810-822
Number of pages13
JournalClinical Journal of the American Society of Nephrology
Volume14
Issue number6
DOIs
StatePublished - Jun 7 2019

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Drug-Eluting Stents
Meta-Analysis
Odds Ratio
Therapeutics
Confidence Intervals
Stents
Thrombosis
Mortality
Incidence
Stroke
Myocardial Infarction
Hemorrhage

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Duration of dual antiplatelet therapy in patients with CKD and drug-eluting stents : A meta-analysis. / Mavrakanas, Thomas A.; Chatzizisis, Yiannis S.; Gariani, Karim; Kereiakes, Dean J.; Gargiulo, Giuseppe; Helft, Gérard; Gilard, Martine; Feres, Fausto; Costa, Ricardo A.; Morice, Marie Claude; Georges, Jean Louis; Valgimigli, Marco; Bhatt, Deepak L.; Mauri, Laura; Charytan, David M.

In: Clinical Journal of the American Society of Nephrology, Vol. 14, No. 6, 07.06.2019, p. 810-822.

Research output: Contribution to journalArticle

Mavrakanas, TA, Chatzizisis, YS, Gariani, K, Kereiakes, DJ, Gargiulo, G, Helft, G, Gilard, M, Feres, F, Costa, RA, Morice, MC, Georges, JL, Valgimigli, M, Bhatt, DL, Mauri, L & Charytan, DM 2019, 'Duration of dual antiplatelet therapy in patients with CKD and drug-eluting stents: A meta-analysis', Clinical Journal of the American Society of Nephrology, vol. 14, no. 6, pp. 810-822. https://doi.org/10.2215/CJN.12901018
Mavrakanas, Thomas A. ; Chatzizisis, Yiannis S. ; Gariani, Karim ; Kereiakes, Dean J. ; Gargiulo, Giuseppe ; Helft, Gérard ; Gilard, Martine ; Feres, Fausto ; Costa, Ricardo A. ; Morice, Marie Claude ; Georges, Jean Louis ; Valgimigli, Marco ; Bhatt, Deepak L. ; Mauri, Laura ; Charytan, David M. / Duration of dual antiplatelet therapy in patients with CKD and drug-eluting stents : A meta-analysis. In: Clinical Journal of the American Society of Nephrology. 2019 ; Vol. 14, No. 6. pp. 810-822.
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T1 - Duration of dual antiplatelet therapy in patients with CKD and drug-eluting stents

T2 - A meta-analysis

AU - Mavrakanas, Thomas A.

AU - Chatzizisis, Yiannis S.

AU - Gariani, Karim

AU - Kereiakes, Dean J.

AU - Gargiulo, Giuseppe

AU - Helft, Gérard

AU - Gilard, Martine

AU - Feres, Fausto

AU - Costa, Ricardo A.

AU - Morice, Marie Claude

AU - Georges, Jean Louis

AU - Valgimigli, Marco

AU - Bhatt, Deepak L.

AU - Mauri, Laura

AU - Charytan, David M.

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Y1 - 2019/6/7

N2 - 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 patientswith drug-eluting stents comparing differentDAPTduration 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 bleedingwas the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. Results Five randomized trials were included (1902 patientswith CKD). Short DAPT (≤6months)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 associatedwith a similar incidence of theprimary outcome comparedwithextendedDAPT(≥30months) 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 (fewevents andwide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.

AB - 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 patientswith drug-eluting stents comparing differentDAPTduration 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 bleedingwas the secondary outcome. The risk ratio (RR) was estimated using a random-effects model. Results Five randomized trials were included (1902 patientswith CKD). Short DAPT (≤6months)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 associatedwith a similar incidence of theprimary outcome comparedwithextendedDAPT(≥30months) 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 (fewevents andwide confidence intervals), no definite conclusions can be drawn with respect to stent thrombosis.

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