Practical issues in clinical scenarios involving CKD patients requiring antithrombotic therapy in light of the 2017 ESC guideline recommendations

Table 2 Duration of treatment and drug combinations in different clinical scenarios

Clinical scenario	Status	Low bleeding risk P-D < 25		Level of evidence/References	High bleeding risk P-D > 25		Level of evidence/References
Clinical scenario	Status	Duration (months)	DAPT	Level of evidence/References	Duration (months)	DAPT	Level of evidence/References
Medical treatment	Stable CAD	No indication for DAPT (unless overridden by prior indications)					[45]
Medical treatment	ACS	12–36	A + T or A + C, but not P (TRILOGY, TRITON [46, 47])	IA [48, 49] IIbB [50] for T60	1 at least, up to 6	A + C, but not A + T in medically treated ACS patients with high bleeding risk in ESC Update	IIaC^a
PCI with stent	Stable CAD	6–30	A + C	IA IIbA [51,52,53,54]	3, lower to 1	A + C	IIaB [55, 56] IIbC [57, 58]
PCI with stent	ACS	12 up to indefinite	A + T or A + P or A + C	IA [46, 48, 49] IIbB [50, 59, 60] for T60^b	6	A + C or A + T	IIaB [8, 61, 62]
BRS		Preferable not to use in persons with high bleeding risk, since DAPT duration is at least 12 months or more (A + P or A + T)					IIaC [63,64,65]

^aNo reference for this in ESC Update
^bPatients >50 years old and with creatinine clearance <60 mL/min/1.73 m²: longer than 12 months (up to indefinite)
A aspirin, ACS acute coronary syndrome, BRS bioresorbable scaffolds, C clopidogrel, CAD coronary artery disease, DAPT dual antiplatelet therapy, P prasugrel, PCI percutaneous coronary intervention, P-D PRECISE-DAPT score, T ticagrelor, T60 Ticagrelor 60 mg b.i.d

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