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Kidney Week

Abstract: TH-PO619

Early Discontinuation of Aspirin Among Patients With CKD Undergoing Percutaneous Coronary Intervention With a Drug Eluting Stent: A Meta-Analysis

Session Information

Category: Hypertension and CVD

  • 1502 Hypertension and CVD: Clinical‚ Outcomes‚ and Trials


  • Festa, Maria Carolina, McGill University Health Centre, Montreal, Quebec, Canada
  • Rasasingam, Sathiepan, McGill University Health Centre, Montreal, Quebec, Canada
  • Sharma, Abhinav, McGill University Health Centre, Montreal, Quebec, Canada
  • Mavrakanas, Thomas, McGill University Health Centre, Montreal, Quebec, Canada

Conflicting evidence exists to support whether short duration of dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy reduces bleeding complications after coronary artery drug-eluting stent (DES) insertion, compared with standard 12-month DAPT, particularly among patients with CKD who are at increased risk of bleeding.


A Medline search identified randomized trials comparing up to 3 months of DAPT followed by P2Y12 inhibitor monotherapy versus twelve months of DAPT after insertion of a DES for any indication. Trials were included if they reported ischemic or bleeding outcomes among patients with CKD (eGFR < 60). The primary outcome was a composite of all-cause mortality, cardiac or cerebrovascular events, stent thrombosis (MACCE), and major bleeding events. Secondary outcomes were the individual components of the primary outcome, and clinically significant bleeding. The relative risk (RR) was estimated using a random-effects model.


Six randomized trials were included for a total of 4,996 patients with CKD (14% of the trial population). Early discontinuation of aspirin was associated with a similar incidence of the primary outcome among patients with CKD compared with twelve-month DAPT (RR 0.97; 95% confidence interval [95% CI] 0.73-1.30). The relative risk of MACCE was also similar between the two arms (RR 1.02; 95% CI 0.85-1.23). The risk of clinically significant bleeding was significantly lower with early discontinuation of aspirin (RR 0.60; 95% CI 0.46-0.78).


P2Y12 inhibitor monotherapy after a shortened course of DAPT is associated with a similar risk of ischemic events and a lower risk of bleeding events after DES insertion among patients with CKD compared with 12-month DAPT.

Relative risk of MACCE and of clinically significant bleeding with P2Y12 inhibitor monotherapy after shortened DAPT (P2Y12 monotherapy) versus 12-month DAPT (DAPT).


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