Investigation of dual antiplatelet therapy after coronary stenting in patients with chronic kidney disease

• Published in: PloS one Vol. 16; no. 8; p. e0255645
• Main Authors: Kao, Chih-Chin, Wu, Mai-Szu, Chuang, Ming-Tsang, Lin, Yi-Cheng, Huang, Chun-Yao, Chang, Wei-Chiao, Chen, Chih-Wei, Chang, Tzu-Hao
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04.08.2021; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Aged, 80 and over; Aggregation; Anticoagulants; Antiplatelet therapy; Bleeding; Blood platelets; Cardiology; Cardiovascular disease; Care and treatment; Chen, Wei; Chronic kidney failure; Classification; Coronary Artery Disease - complications; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Drug-Eluting Stents - adverse effects; Dual Anti-Platelet Therapy - adverse effects; Female; Health risks; Heart attacks; Hemoglobin; Hemorrhage - etiology; Hospitals; Humans; Implants; Internal medicine; Ischemia; Ischemic Stroke - etiology; Ischemic Stroke - prevention & control; Kidney diseases; Kidneys; Male; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - etiology; Myocardial Infarction - prevention & control; Nephrology; Patient outcomes; Patients; Percutaneous Coronary Intervention - adverse effects; Pharmacy; Platelet Aggregation Inhibitors - adverse effects; Renal Insufficiency, Chronic - complications; Retrospective Studies; Risk; Stent (Surgery); Stents; Surgical implants; Thrombolysis; Treatment Outcome; Urology; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0255645

Dual antiplatelet therapy (DAPT) is currently the standard treatment for the prevention of ischemic events after stent implantation. However, the optimal DAPT duration remains elusive for patients with chronic kidney disease (CKD). Therefore, we aimed to compare the effectiveness and safety between long-term and short-term DAPT after coronary stenting in patients with CKD. This retrospective cohort study analyze data from the Taipei Medical University (TMU) Institutional and Clinical Database, which include anonymized electronic health data of 3 million patients that visited TMU Hospital, Wan Fang Hospital, and Shuang Ho Hospital. We enrolled patients with CKD after coronary stenting between 2008 and 2019. The patients were divided into the long-term (>6 months) and short-term DAPT group (≤ 6 months). The primary end point was major adverse cardiovascular events (MACE) from 6 months after the index date. The secondary outcomes were all-cause mortality and Thrombolysis in Myocardial Infarction (TIMI) bleeding. A total of 1899 patients were enrolled; of them, 1112 and 787 were assigned to the long-term and short-term DAPT groups, respectively. Long-term DAPT was associated with similar risk of MACE (HR: 1.05, 95% CI: 0.65-1.70, P = 0.83) compare with short-term DAPT. Different CKD risk did not modify the risk of MACE. There was also no significant difference in all-cause mortality (HR: 1.10, 95% CI: 0.75-1.61, P = 0.63) and TIMI bleeding (HR 1.19, 95% CI: 0.86-1.63, P = 0.30) between groups. Among patients with CKD and coronary stenting, we found that long-term and short-term DAPT tied on the risk of MACE, all-cause mortality and TIMI bleeding.