RESUMO
Background and objectives Whether prolonged dual antiplatelet therapy (DAPT) is more protective in patients with CKD and drug elutings tents compared with shorter DAPT isuncertain.The purposeofthismeta-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.Inclusionof patients with CKD was alsorequired. The primary outcome was acomposite of all-cause mortality, myocardial infarction,stroke,orstent thrombosis (deï¬niteorprobable).Major bleeding was the secondary outcome.Therisk ratio (RR) was estimated using a random-effects model. Results Five randomized trials were included (1902 patient swith 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% conï¬dence 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 eventrates were detected with shorter versus 12-monthDAPT(9versus13events;RR,0.69;95%CI,0.30 to1.60;P=0.39)and12-month versus extended DAPT( 9 versus 12 events;RR,0.83;95%CI,0.35to1.93;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 imprecisioninestimates (feweventsandwide conï¬dence intervals),nodeï¬nite conclusion scan be drawn with respect to stent thrombosis. (AU)