Dual Antiplatelet Therapy and Clinical Outcomes after Coronary Drug-Eluting Stent Implantation in Patients on Hemodialysis.
We aimed to investigate the benefits and risks of dual antiplatelet therapy (DAPT) after coronary drug-eluting stent (DES) implantation in patients undergoing hemodialysis.



A nested case-control analysis of patients on hemodialysis after receipt of DES and DAPT treatment was conducted using data from Taiwan's National Health Insurance Research Database for the period 2007-2011. Cases of myocardial infarction or death within 1 year after DES implantation were matched one-to-one with control patients. Odds ratios were calculated to compare DAPT continuation with discontinuation. Additionally, a propensity score-adjusted 6-month landmark cohort analysis was also conducted to evaluate the long-term benefits and risks of prolonged (>6 months) compared with ≤6 months of DAPT use. The primary outcomes were death and myocardial infarction. The secondary outcomes were ischemic stroke, revascularization, and major bleeding.



In the nested case-control analysis, patients who continued DAPT had a lower rate of death or myocardial infarction within 1 year after receipt of a DES (adjusted odds ratio, 0.54; 95% confidence interval, 0.36 to 0.81; P=0.003), whereas this association became statistically nonsignificant when compared with patients who discontinued DAPT for the period between 6 and 12 months after receipt of a DES (adjusted odds ratio, 1.51; 95% confidence interval, 0.75 to 3.04). In the propensity score-adjusted cohort analysis, >6 months of DAPT use was not associated with different primary or secondary outcomes than shorter-term use.



Our findings support that the clinical effectiveness of extended DAPT in a hemodialysis population may be tempered after 6 months post-DES implantation.
Divisions of *Nephrology and.|Institute of Clinical Medicine.
Yung-Tai
YT
Chen
Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan.|School of Medicine, and.
Hung-Ta
HT
Chen
Institute of Clinical Medicine.|Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan.|Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.|College of Medicine and.
Chien-Yi
CY
Hsu
College of Medicine and.|Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Pei-Wen
PW
Chao
School of Medicine, and.
Shu-Chen
SC
Kuo
Institute of Clinical Medicine.|Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; and.
Shuo-Ming
SM
Ou
School of Medicine, and.|Deran Clinic, Yilan, Taiwan.
Chia-Jen
CJ
Shih
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D016022:Case-Control Studies; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D057216:Propensity Score; D006435:Renal Dialysis; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
2′-deoxythymidylyl-(3′-5′)-2′-deoxyadenosine; Cohort; Drug-Eluting Stents; Epidemiology and outcomes; Hemorrhage; Humans; Myocardial Infarction; National Health Programs; Odds Ratio; Propensity Score; Risk Assessment; Stroke; Studies; Taiwan; Treatment Outcome; coronary artery disease; hemodialysis; renal dialysis