Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents: A Meta-Analysis.
Coronary Disease
/ complications
Drug Therapy, Combination
Drug-Eluting Stents
Hemorrhage
/ chemically induced
Humans
Myocardial Infarction
/ prevention & control
Platelet Aggregation Inhibitors
/ administration & dosage
Prosthesis Failure
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic
/ complications
Stroke
/ prevention & control
Thrombosis
/ prevention & control
Time Factors
Drug-Eluting Stents
Hemorrhage
Incidence
Myocardial Infarction
Odds Ratio
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic
Risk
Stroke
all-cause mortality
chronic kidney disease
drug-eluting stents
major bleeding
myocardial infarction
thrombosis
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 06 2019
07 06 2019
Historique:
received:
31
10
2018
accepted:
27
03
2019
pubmed:
24
4
2019
medline:
23
9
2020
entrez:
24
4
2019
Statut:
ppublish
Résumé
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. 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. 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; 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.
Sections du résumé
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;
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.
Identifiants
pubmed: 31010936
pii: 01277230-201906000-00008
doi: 10.2215/CJN.12901018
pmc: PMC6556713
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
810-822Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
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