Duration of dual antiplatelet treatment after percutaneous coronary intervention in patients with chronic kidney disease: a systematic review and meta-analysis

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Patients suffering from chronic kidney disease (CKD) have higher ischemic and bleeding risk compared with patients with normal renal function. The aim of our systematic review and meta-analysis is to compare shortened (≤3 months) dual antiplatelet therapy (DAPT) with longer DAPT in patients with CKD undergoing percutaneous coronary interventions. We systematically screened three major databases (Medline, Cochrane Central Register of Controlled Trials, and Scopus) searching for randomized-controlled trials or subanalyses of them, which compared shortened (S-DAPT) to longer (L-DAPT) regimens of DAPT in patients with CKD. The primary endpoint is the net adverse clinical events (NACE) and the secondary is major adverse cardiac events (MACE), and bleedings. Subgroup analyses included studies using only P2Y12 monotherapy, ticagrelor-based regimens, 1- and 3-month duration of DAPT. A total of 10 studies and 6688 patients were included in our analysis. No significant differences regarding NACE (RR: 0.97, 95% CI: 0.84-1.12, I2 = 0%), MACE (RR: 1.00, 95% CI: 0.85-1.117, I2 = 0%), and bleedings (RR: 0.78, 95% CI: 0.59-1.03, I2 = 25%) were observed between S-DAPT and L-DAPT in our meta-analysis. The findings from the subgroup analyses were in accordance with total findings; bleedings were significantly reduced in S-DAPT when only studies with 3-month duration of DAPT were analyzed (RR: 0.58, 95% CI: 0.40-0.85, I2 = 0%). Our systematic review and meta-analysis showed that no significant differences were observed between patients treated with S-DAPT or L-DAPT in the terms of MACE, NACE, and bleedings in patients with CKD. When it is required, S-DAPT could be considered in patients with CKD.

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