Key result
Ticagrelor-based DAPT reduces MACE ~11% vs. clopidogrel in patients with ACS and CKD.
Why the study?
Patients with acute coronary syndrome and chronic kidney disease face heightened risks of adverse cardiovascular events and bleeding, making an optimal antiplatelet strategy needed.
Does ticagrelor-based DAPT improve clinical outcomes compared to clopidogrel-based DAPT in patients with acute coronary syndrome and chronic kidney disease?
Meta-Analysis (n=9,947)
Does ticagrelor-based DAPT improve clinical outcomes compared to clopidogrel-based DAPT in patients with acute coronary syndrome and chronic kidney disease?
Relative Risk: 0.89 (95% CI 0.8–0.99)
p-value: p=0.04
In patients with ACS and CKD, ticagrelor-based DAPT reduces MACE compared to clopidogrel-based DAPT without increasing major bleeding, while shortening DAPT duration does not appear beneficial.
Supports ticagrelor-based DAPT in ACS with CKD; extends RCT evidence to this high-risk subgroup without excess bleeding.
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. Methods: We conducted a systematic review and meta-analysis to evaluate comparative advantages of clopidogrel vs. 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: = 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. Conclusions: 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.
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Li et al. (2025) conducted a meta-analysis in Acute coronary syndrome and chronic kidney disease (n=9,947). Ticagrelor vs. Clopidogrel was evaluated on Major adverse cardiovascular events (MACE) (RR 0.89, 95% CI 0.80-0.99, p=0.04). Ticagrelor-based dual antiplatelet therapy reduced the risk of major adverse cardiovascular events by 11% (RR 0.89) compared to clopidogrel in patients with acute coronary syndrome and chronic kidney disease.
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