Efficacy and Safety of Different Durations of Dual Antiplatelet Therapy for Acute Coronary Syndrome in Patients with Chronic Kidney Disease: A Systematic Review
Aileen Alessandra Suryohusodo, Alius Cahyadi, Charens Tjhin, Maria Riastuti IryaningrumBackground
In this systematic review, we evaluated the efficacy and safety of different durations of dual antiplatelet therapy (DAPT), which consists of aspirin and a P2Y12 inhibitor, in patients with concomitant chronic kidney disease (CKD) and acute coronary syndrome (ACS).
Materials and Methods
We searched PubMed, Cochrane, and Proquest from inception to January 2024 with the terms “acute coronary syndrome,” “chronic kidney disease,” and “dual antiplatelet therapy”, and a ten-year publication date restriction. We included observational studies that assessed the impact of DAPT on major adverse cardiovascular events (MACE) and safety outcomes, specifically major and minor bleeding events. The included studies involved patients with ACS diagnoses who also had CKD. Risk of bias assessment was assessed regarding selection, comparability, and outcome.
Results
We included eight studies involving 166,290 participants—six studies with a retrospective design and two with a prospective design. The quality of evidence was generally good. Six studies showed a significantly difference incidence of MACE in prolonged DAPT administration, in which five of them showed a decreased incidence. One study reported a higher two-year mortality in patients with CKD and prolonged DAPT compared to the general population. Bleeding risks were increased significantly in prolonged DAPT in two studies, five studies reported no significant difference in bleeding incidence, and one study reported a higher rate of adverse outcomes in lower estimated glomerular filtration rate compared to healthy patients when given DAPT for > 12 months.
Conclusion
Prolonged DAPT administration may decrease the risk of MACE with no increased risk in bleeding occurrences in patients with concomitant CKD and ACS.