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

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 (definiteorprobable).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% confidence 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 confidence intervals),nodefinite conclusion scan be drawn with respect to stent thrombosis. (AU)

Short term versus long term dual antiplatelet therapy after implantation of drug eluting stent in patients with or without diabetes: systematic review and meta-analysis of individual participant data from randomised trials

OBJECTIVE: To compare clinical outcomes between short term (up to 6 months) and long term (12 months) dual antiplatelet therapy (DAPT) after placement of a drug eluting stent in patients with and without diabetes.DESIGN: Individual participant data meta-analysis. Cox proportional regression models stratified by trial were used to assess the impact of diabetes on outcomes.DATA SOURCE: Medline, Embase, and Cochrane databases and proceedings of international meetings searched for randomised controlled trials comparing durations of DAPT after placement of a drug eluting stent. Individual patient data pooled from six DAPT trials.PRIMARY OUTCOME: Primary study outcome was one year risk of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, or definite/probable stent thrombosis. All analyses were conducted by intention to treat...