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Duration of dual antiplatelet therapy in patients with CKD and drug-eluting stents: a meta analysis
Mavrakanas, Thomas A; Chatzizisis, Yiannis S; Gariani, Karim; Kereiakes, Dean J; Gargiulo, Giuseppe; Helft, Gérard; Gilard, Martine; Feres, Fausto; Costa, Ricardo A; Morice, Marie Claude; Georges, Jean Louis; Valgimigli, Marco; Bhatt, Deepak L; Mauri, Laura; Charytan, David M.
Afiliação
  • Mavrakanas, Thomas A; Brigham and Women's Hospital. Harvard Medical School. Geneva University Hospitals. Boston. US
  • Chatzizisis, Yiannis S; Universityof Nebraska Medical Center. Nebraska. US
  • Gariani, Karim; Geneva University Hospitals. Genebra. CH
  • Kereiakes, Dean J; The Christ Hospital Heart And Vascular. Ohio. US
  • Gargiulo, Giuseppe; University Hospital Bern. University of Naples Federico II. Napoles. IT
  • Helft, Gérard; University Hospitals Pitie. Paris. FR
  • Gilard, Martine; Hôpital la Cavale Blanche. Brest. FR
  • Feres, Fausto; Institute Dante Pazzanese de Cardiologia. São Paulo. BR
  • Costa, Ricardo A; Institute Dante Pazzanese de Cardiologia. São Paulo. BR
  • Morice, Marie Claude; Hôpital Jacques Cartier. Massy. FR
  • Georges, Jean Louis; Hospital of Versailles. Le Chesnay. FR
  • Valgimigli, Marco; University Hospital Bern. Berna. CH
  • Bhatt, Deepak L; Harvard Medical School. Boston. US
  • Mauri, Laura; Brigham and Women's Hospital. Boston. US
  • Charytan, David M; Brigham and Women's Hospital. Baim Institute for Clinical Research. University Langone Medical Center New York. Boston. US
Clin. j. am. soc. nephrol ; 14(6): 810-822, Jun 2019. tabela, grafico
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1022675
Biblioteca responsável: BR79.1
Localização: BR79.1
ABSTRACT
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)
Assuntos

Texto completo: Disponível Coleções: Bases de dados nacionais / Brasil Base de dados: Sec. Est. Saúde SP / SESSP-IDPCPROD Assunto principal: Distúrbio Mineral e Ósseo na Doença Renal Crônica / Inibidores da Agregação Plaquetária / Stents Farmacológicos Tipo de estudo: Ensaio clínico controlado / Revisão sistemática Limite: Humanos Idioma: Inglês Revista: Clin. j. am. soc. nephrol Ano de publicação: 2019 Tipo de documento: Artigo Instituição/País de afiliação: Brigham and Women's Hospital/US / Geneva University Hospitals/CH / Harvard Medical School/US / Hospital of Versailles/FR / Hôpital Jacques Cartier/FR / Hôpital la Cavale Blanche/FR / Institute Dante Pazzanese de Cardiologia/BR / The Christ Hospital Heart And Vascular/US / University Hospital Bern/CH / University Hospital Bern/IT

Texto completo: Disponível Coleções: Bases de dados nacionais / Brasil Base de dados: Sec. Est. Saúde SP / SESSP-IDPCPROD Assunto principal: Distúrbio Mineral e Ósseo na Doença Renal Crônica / Inibidores da Agregação Plaquetária / Stents Farmacológicos Tipo de estudo: Ensaio clínico controlado / Revisão sistemática Limite: Humanos Idioma: Inglês Revista: Clin. j. am. soc. nephrol Ano de publicação: 2019 Tipo de documento: Artigo Instituição/País de afiliação: Brigham and Women's Hospital/US / Geneva University Hospitals/CH / Harvard Medical School/US / Hospital of Versailles/FR / Hôpital Jacques Cartier/FR / Hôpital la Cavale Blanche/FR / Institute Dante Pazzanese de Cardiologia/BR / The Christ Hospital Heart And Vascular/US / University Hospital Bern/CH / University Hospital Bern/IT
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