Larry R Jackson1, Christine Ju2, Marjorie Zettler3, John C Messenger4, David J Cohen5, Gregg W Stone6, Brian A Baker7, Mark Effron3, Eric D Peterson2, Tracy Y Wang2. 1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: larry.jackson@dm.duke.edu. 2. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. 3. Lilly USA, LLC, Indianapolis, Indiana. 4. University of Colorado School of Medicine, Aurora, Colorado. 5. Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. 6. Columbia University College of Physicians and Surgeons, New York, New York. 7. Daiichi-Sankyo, Inc., Parsippany, New Jersey.
Abstract
OBJECTIVES: The purpose of this study was to determine whether bleeding risk varies depending on which P2Y12 receptor inhibitor agent is used. BACKGROUND: Prior studies have shown significant bleeding risk among patients treated with triple therapy (i.e., oral anticoagulant, P2Y12 receptor inhibitor, and aspirin). METHODS: We evaluated patients with acute myocardial infarction (MI) treated withpercutaneous coronary intervention (PCI) at 233 hospitals in the United States enrolled in the TRANSLATE-ACS (Treatment withAdenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study (April 2010 to October 2012). Using inverse probability-weighted propensity modeling, we compared 6-month adjusted risks of Bleeding Academic Research Consortium (BARC) bleeding, stratifying by whether or not bleeding was associated with rehospitalization among patients discharged on aspirin + anticoagulant + clopidogrel (triple-C), aspirin + anticoagulant + prasugrel (triple-P), aspirin + clopidogrel (dual-C), or aspirin + prasugrel (dual-P). RESULTS: Of 11,756 MI patients, 526 (4.5%) were discharged on triple-C, 91 (0.8%) on triple-P, 7,715 (66%) on dual-C, and 3,424 (29%) on dual-P. Compared with dual-therapy patients, triple-therapy patients had significantly higher any BARC-defined bleeding. Triple-P was associated with a greater risk of any BARC-defined bleeding events compared with triple-C. This finding was driven mostly by an increased risk of bleeding events that were patient-reported only and did not require rehospitalization. There were no significant differences in bleeding requiring rehospitalization between the triple-P and -C groups. CONCLUSIONS: Among MI patients, the addition of an oral anticoagulant was associated with a significantly greater risk of any BARC-defined bleeding relative to dual antiplatelet therapy, regardless of which P2Y12 receptor inhibitor was selected. Among patients on triple therapy, prasugrel use was associated with higher patient-reported-only bleeding, but not bleeding requiring rehospitalization, than clopidogrel-treated patients.
RCT Entities:
OBJECTIVES: The purpose of this study was to determine whether bleeding risk varies depending on which P2Y12 receptor inhibitor agent is used. BACKGROUND: Prior studies have shown significant bleeding risk among patients treated with triple therapy (i.e., oral anticoagulant, P2Y12 receptor inhibitor, and aspirin). METHODS: We evaluated patients with acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) at 233 hospitals in the United States enrolled in the TRANSLATE-ACS (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study (April 2010 to October 2012). Using inverse probability-weighted propensity modeling, we compared 6-month adjusted risks of Bleeding Academic Research Consortium (BARC) bleeding, stratifying by whether or not bleeding was associated with rehospitalization among patients discharged on aspirin + anticoagulant + clopidogrel (triple-C), aspirin + anticoagulant + prasugrel (triple-P), aspirin + clopidogrel (dual-C), or aspirin + prasugrel (dual-P). RESULTS: Of 11,756 MI patients, 526 (4.5%) were discharged on triple-C, 91 (0.8%) on triple-P, 7,715 (66%) on dual-C, and 3,424 (29%) on dual-P. Compared with dual-therapy patients, triple-therapy patients had significantly higher any BARC-defined bleeding. Triple-P was associated with a greater risk of any BARC-defined bleeding events compared with triple-C. This finding was driven mostly by an increased risk of bleeding events that were patient-reported only and did not require rehospitalization. There were no significant differences in bleeding requiring rehospitalization between the triple-P and -C groups. CONCLUSIONS: Among MI patients, the addition of an oral anticoagulant was associated with a significantly greater risk of any BARC-defined bleeding relative to dual antiplatelet therapy, regardless of which P2Y12 receptor inhibitor was selected. Among patients on triple therapy, prasugrel use was associated with higher patient-reported-only bleeding, but not bleeding requiring rehospitalization, than clopidogrel-treated patients.
Authors: Brian J Potter; Giuseppe Andò; Giovanni Cimmino; Ricardo Ladeiras-Lopes; Zied Frikah; Xin Yue Chen; Vittorio Virga; Joao Goncalves-Almeida; A John Camm; Keith A A Fox Journal: Clin Cardiol Date: 2018-04-17 Impact factor: 2.882
Authors: Florentino Lupercio; Shaun Giancaterino; Pedro Arturo Villablanca; Frederick Han; Kurt Hoffmayer; Gordon Ho; Farshad Raissi; David Krummen; Ulrika Birgersdotter-Green; Gregory Feld; Ryan Reeves; Ehtisham Mahmud; Jonathan C Hsu Journal: Heart Date: 2020-02-07 Impact factor: 5.994
Authors: Eric A Secemsky; Neel M Butala; Uri Kartoun; Sadiqa Mahmood; Jason H Wasfy; Kevin F Kennedy; Stanley Y Shaw; Robert W Yeh Journal: J Am Heart Assoc Date: 2016-10-17 Impact factor: 5.501