RE: Effects of antiplatelet therapy on mortality and cardiovascular and bleeding outcomes in persons with chronic kidney disease

Dr. Kussmaul raises an important point: Does evidence from a randomized, controlled trial (RCT) tell us whether patients with CKD should receive aspirin and clopidogrel for 12 months after coronary artery stenting? In the general population, guidelines recommend antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) for 12 months after percutaneous stent insertion, unless the risk for morbidity from bleeding outweighs the anticipated benefits, in which earlier discontinuation from the P2Y12 inhibitor is reasonable. Applying the evidence from the general population to patients with CKD may be inappropriate because of the increased risk for bleeding. Our systematic review has highlighted that data to address the question of dual-antiplatelet therapy after stenting in patients with CKD are scant. The benefits and harms of aspirin are unknown, and the role of clopidogrel after coronary intervention is explored by 2 RCTs that both observed uncertain benefits and harms of 12 months of clopidogrel treatment. We need to acknowledge this current uncertainty and promote more research.