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REVIEW article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1527667
This article is part of the Research Topic New Concepts in Revascularization Strategies and Antithrombotic Therapies in Patients With Non-ST Elevated Acute Coronary Syndromes View all articles
Antiplatelet strategy for patients with acute coronary syndrome and chronic kidney disease: a systematic review and metaanalysis
Provisionally accepted- 1 Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- 2 Cardiovascular Institute, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Beijing, China
- 3 Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Beijing, China
Background: Patients with both acute coronary syndrome (ACS) and chronic kidney disease (CKD) face heightened risks of adverse cardiovascular events and bleeding. An optimal antiplatelet strategy for this patient population is needed.We conducted a systematic review and meta-analysis to evaluate comparative advantages of clopidogrel versus ticagrelor in the choice of dual antiplatelet therapy (DAPT) strategies for patients with ACS combined with CKD, while also exploring the appropriate duration of DAPT in the presence of CKD. Relevant studies were retrieved from PubMed, Embase, Cochrane Library, and Web of Science. The primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and major bleeding. Data were analyzed using RevMan 5.4.1, and STATA 14 was used to assess publication bias. This study was registered with PROSPERO (CRD42024593764).Results: Six studies involving 9,947 patients met the inclusion criteria. Compared with clopidogrel, ticagrelor was associated with a reduced risk of MACE (RR: 0.89, 95% CI: 0.80-0.99; P = 0.04) and stroke (RR: 0.66, 95% CI: 0.45-0.96; P = 0.03) in patients receiving DAPT. No significant differences were observed in all-cause mortality, major bleeding, cardiovascular death, or acute myocardial infarction. Three studies on DAPT duration showed a consistent trend, indicating that shortening DAPT duration did not benefit patients.In patients with ACS combined with CKD, ticagrelor-based DAPT has advantages over clopidogrel-based DAPT, which is associated with a lower incidence of MACE. And shortening the duration of DAPT does not improve clinical outcomes.
Keywords: Dual antiplatelet therapy, Acute Coronary Syndrome, Chronic Kidney Disease, ticagrelor, clopidogrel
Received: 13 Nov 2024; Accepted: 11 Feb 2025.
Copyright: © 2025 Li, Wang, Han, Zhang, Deng and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Guozhong Pan, Second Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China., Beijing, China
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