Kidney Week

Abstract: FR-PO373

Duration of Dual Antiplatelet Therapy in Patients with CKD and Drug-Eluting Stents: A Meta-Analysis

Session Information

• Hypertension and CVD: Clinical, Outcomes, Trials
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

• Mavrakanas, Thomas, Brigham & Women's Hospital, Boston, United States

Thomas Mavrakanas,

• Chatzizisis, Yiannis, UNMC, Omaha, Nebraska, United States

Yiannis Chatzizisis,

• Gariani, Karim, Geneva University Hospital, Geneva, Switzerland

Karim Gariani,

• Kereiakes, Dean J., The Christ Hospital, Cincinnati, Ohio, United States

Dean J. Kereiakes,

• Gargiulo, Giuseppe, Bern University Hospital, Bern, Switzerland

Giuseppe Gargiulo,

• Feres, Fausto, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil

Fausto Feres,

• Morice, Marie claude, Générale de Santé - Institut Cardiovasculaire Paris Sud, MASSY, France

Marie claude Morice,

• Georges, Jean-Louis, Centre Hospitalier de Versailles, LE CHESNAY, France

Jean-Louis Georges,

• Valgimigli, Marco, University Hospital Bern, Bern, Switzerland

Marco Valgimigli,

• Bhatt, Deepak L., Brigham and Women''s Hospital, Newton, Massachusetts, United States

Deepak L. Bhatt,

• Mauri, Laura, Brigham and Women''s Hospital, Newton, Massachusetts, United States

Laura Mauri,

• Charytan, David M., Brigham and Women's Hospital/Harvard Medical School, Brookline, Massachusetts, United States

David M. Charytan,

Background

Whether prolonged dual antiplatelet therapy (DAPT) is more protective in chronic kidney disease (CKD) patients with drug-eluting stents (DES) compared with shorter DAPT is uncertain. This meta-analysis examined whether shorter DAPT in patients with DES and CKD is associated with lower mortality or major adverse cardiovascular event rates compared with longer DAPT.

Methods

A Medline literature research was conducted to identify randomized trials in patients with DES comparing different DAPT duration strategies. The primary outcome was a composite of all-cause mortality, myocardial infarction, stroke, or stent thrombosis (definite- probable). The secondary outcome was major bleeding. A random-effects model was used.

Results

Five randomized controlled trials were included (1,902 CKD patients). Short DAPT (≤6 months) was associated with a similar incidence of the primary outcome, compared with 12-months DAPT among patients with CKD (Figure). Twelve-months DAPT was also associated with a similar incidence of the primary outcome compared with extended DAPT (≥30 months) in the CKD subgroup (Figure). Numerically lower major bleeding event rates were detected with shorter vs. 12-month DAPT (RR 0.68, 95% CI 0.29-1.60, p=0.38) and 12-month vs. extended DAPT (RR 0.82, 95% CI 0.34-1.94, p=0.65) in CKD patients.

Conclusion

Short DAPT may be preferred to longer DAPT in CKD patients with DES.

Forest plot showing the impact of short (≤6 months), 12-month, and extended (>=30 months) dual antiplatelet therapy on the composite primary outcome, a composite of all-cause mortality, myocardial infarction, stroke, and stent thrombosis (definite or probable) in patients with chronic kidney disease.