The PAR4 platelet thrombin receptor variant rs773902 does not impact the incidence of thrombotic or bleeding events in a healthy older population

2021 ◽  
Author(s):  
Maria V Selvadurai ◽  
Moeen Riaz ◽  
Sophia Xie ◽  
Andrew Tonkin ◽  
John J McNeil ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Bleeding Event ◽  
Major Adverse Cardiovascular Events ◽  
Thrombin Receptor ◽  
Sequence Variant ◽  
Older Individuals ◽  
Bleeding Events ◽  
Older Population ◽  
Major Hemorrhage ◽  
Thrombotic Risk

Background: Protease-activated receptor 4 (PAR4) is a platelet thrombin receptor important for thrombosis and a target of anti-platelet drug development. A frequently occurring single nucleotide polymorphism (SNP; rs773902) causes a PAR4 sequence variant (NC_000019.10:p.Ala120Thr) whereby platelets from Thr120-expressing individuals are hyper-responsive to PAR4 agonists versus platelets from Ala120-expressing individuals. However, whether this enhanced platelet responsiveness translates to increased thrombotic risk or decreased bleeding risk remains unknown. Objectives: To examine the association of rs773902 with adjudicated cardiovascular events and aspirin use in a randomized trial population of healthy older individuals. Patients/Methods: We analyzed 13,547 participants in the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Participants had no previous cardiovascular events at enrollment and were randomized to either 100 mg daily aspirin or placebo for a median follow-up of 4.7 years. Total genotypes were 8,761 (65%) GG (Ala120 variant), 4,303 (32%) heterozygotes, and 483 (4%) AA (Thr120 variant). Cox proportional hazard regression tested the relationship between rs773902 and thrombotic events (major adverse cardiovascular events [MACE] and ischemic stroke [IS]) and bleeding (major hemorrhage [MHEM] and intracranial bleeding [ICB]). Results: No statistically significant association was observed overall or by treatment group between rs773902 and any thrombotic or bleeding event examined. Further, there was no significant interaction between rs773902 and treatment for any of MACE, IS, MHEM, or ICB. Conclusions: This post-hoc analysis of a prospective cohort study suggests that, despite sensitizing platelet activation, the rs773902 PAR4 variant is not associated with thrombotic cardiovascular or bleeding events in a healthy older population.

scholarly journals A Comparison of Contemporary versus Older Studies of Aspirin for Primary Prevention

2019 ◽  
Author(s):  
Frank Moriarty ◽  
Mark H. Ebell
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Primary Prevention ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
List Type ◽  
Cancer Death ◽  
Major Hemorrhage ◽  
Before And After ◽  
Modern Era

AbstractObjectiveThis study compares the benefits and harms of aspirin for primary prevention before and after widespread use of statins and colorectal cancer screening.MethodsWe compared studies of aspirin for primary prevention that recruited patients from 2005 onward with previous individual patient meta-analyses that recruited patients from 1978 to 2002. Data for contemporary studies were synthesized using random-effects models. We report vascular (major adverse cardiovascular events [MACE], myocardial infarction [MI], stroke), bleeding, cancer, and mortality outcomes.ResultsThe IPD analyses of older studies included 95,456 patients for CV prevention and 25,270 for cancer mortality, while the four newer studies had 61,604 patients. Relative risks for vascular outcomes for older vs newer studies follow: MACE: 0.89 (95% CI 0.83-0.95) vs 0.93 (0.86-0.99); fatal hemorrhagic stroke: 1.73 (1.11-2.72) vs 1.06 (0.66-1.70); any ischemic stroke: 0.86 (0.74-1.00) vs 0.86 (0.75-0.98); any MI: 0.84 (0.77-0.92) vs 0.88 (0.77-1.00); and non-fatal MI: 0.79 (0.71-0.88) vs 0.94 (0.83-1.08). Cancer death was not significantly decreased in newer studies (RR 1.11, 0.92-1.34). Major hemorrhage was significantly increased for both older and newer studies (RR 1.48, 95% CI 1.25-1.76 vs 1.37, 95% CI 1.24-1.53). There was no effect in either group on all-cause mortality, cardiovascular mortality, fatal stroke, or fatal MI.ConclusionsIn the modern era characterized by widespread statin use and cancer screening, aspirin does not reduce the risk of non-fatal MI or cancer death. There are no mortality benefits and a significant risk of major hemorrhage. Aspirin should no longer be recommended for primary prevention.Summary of current evidence and what this study addsWhat is already known about this subject?The cumulative evidence for aspirin suggests a role in the primary prevention of cardiovascular disease, and in reducing cancer incidence and mortality.However most of the trials of aspirin for primary prevention were set in Europe and the United States and recruited patients prior to the year 2000.The benefits and harms of aspirin should be considered separately in studies performed in the eras before and after widespread use of statins and colorectal cancer screening.What does this study add?This study provides the most detailed summary to date of cardiac, stroke, bleeding, mortality and cancer outcomes to date in the literature.In trials of aspirin for primary prevention from 2005 onwards, aspirin reduced major adverse cardiovascular events but significantly increased the risk of bleeding, with no benefit for mortality or,Unlike older studies, there was no reduction in cancer mortality and non-fatal myocardial infarction.How does this impact on clinical practice?Our study suggests aspirin should not be recommended for primary prevention in the modern era.

Are glycoprotein inhibitors safe during percutaneous coronary intervention in patients on chronic warfarin treatment?

2009 ◽  
Vol 102 (12) ◽  
pp. 1227-1233 ◽  
Author(s):  
Heli Lahtela ◽  
Pasi Karjalainen ◽  
Matti Niemelä ◽  
Saila Vikman ◽  
Kari Kervinen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Warfarin Therapy ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Bleeding Events ◽  
Hospital Variation ◽  
Percutaneous Coronary

SummaryThe aim of this study was to evaluate the safety of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI) in patients on chronic warfarin therapy due to atrial fibrillation (AF).We analysed all consecutive AF patients (N = 377, mean age 70 years, male 71%) on warfarin therapy referred for PCI in seven centres. Major bleeding, access site complications and major adverse cardiovascular events were recorded during hospitalisation. A total of 111 patients (29%) received periprocedural GPIs with a wide inter-hospital variation in their use (range 3–68%).The use of GPIs increased with the severity of the disease presentation and 49% of patients with ST-elevation myocardial infarction received GPIs. Mean periprocedural international normalised ratio (INR) of patients who received GPIs was 1.89 (range 1.1–3.3). Major bleeding was more common in the patients treated with GPIs (9.0% vs. 1.5%, p = 0.001) than in those without GPIs, but there was no difference in major adverse cardiovascular events between the groups. In multivariable analysis, use of GPIs (odds ratio [OR]???????????5.1, 95% confidence interval [CI]???????????1.3–20.6, p = 0.02) and old age (OR 1.2, 95% CI 1.0–1.3, p = 0.02) remained as the only independent predictors of major bleeding. Also after adjusting for propensity score, GPIs remained as a significant predictor of major bleeding (OR 3.8, 95% CI 1.03–14.1, p = 0.045). In the GPI group, major bleeding was not predicted by INR level or warfarin pause. GPIs increase the risk of major bleeding events irrespective of periprocedural INR levels and should be used with caution in this fragile patient group.

A phase I feasability study of concurrent fondaparinux (F) with carboplatin (Crb) and paclitaxel (P) for metastatic non-small cell lung cancer (NSCLC): An analysis of coagulation/angiogenic biomarker (CABM) kinetics.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19143-e19143
Author(s):  
David James Mooney ◽  
Debi Miley ◽  
Mary Jerome ◽  
Stefan C. Grant ◽  
Francisco Robert
Keyword(s):  
Major Bleeding ◽  
Metastatic Cancer ◽  
Bleeding Event ◽  
Stage Iv ◽  
Endothelial Damage ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Angiogenic Biomarkers

e19143 Background: There is an association between risk of thrombosis and metastatic cancer. Chemotherapy (C) also independently increases thrombotic risk. This increased risk is multifactorial, including endothelial damage and release of angiogenic cytokines. We hypothesized that adding anticoagulation to C may decrease thrombotic risk and also, potentially, have anti-tumor effect. Methods: The primary aim of this study was to determine the tolerability and safety (bleeding events) of the combination of F with 21-day cycle chemotherapy (Crb AUC 6 + P 200 mg/m2) in two cohorts of untreated patients (pts) with stage IV NSCLC. The secondary objectives were to determine incidence of venous thrombosis (VT), changes in CABM parameters during treatment, and clinical efficacy endpoints. Two cohorts of pts received F from cycles 2-4 with Crb+P. Cohort A received 2.5 mg F daily from cycle 2-4. Cohort B received 7.5 mg of F on day 1, 2 of cycle 2-4 and 2.5 mg F on day 3-21. Results: Clinical data from 19 evaluable pts are as follows: median age 55 years, 63% male, and 32% adenocarcinoma. There was no major bleeding event (BE) in either cohort, and 5 pts had a minor BE. There was no VT. Median time to progression was 5 months (3.8-6.2 months), and overall survival was 10 months (4.3-15.6 months). Baseline values of sensitive markers of activated coagulation (D-Dimer, Thrombin Anti-Thrombin Complex) were above the normal range in most patients. These biomarkers tended to increase during the first cycle (without F); whereas the same markers decreased during the second cycle (with F). A reduction of the angiogenic biomarkers during therapy was observed with VEGF, TGF-β1, and Angiopoietin-1. Conclusions: Concurrent treatment with F and chemotherapy for metastatic NSCLC is feasible with no major bleeding and little minor bleeding. During chemotherapy, coagulant and angiogenic biomarkers tended to increase, perhaps suggesting an increase in thrombogenic state. When F was added, these markers trended downward, suggesting that the proangiogenic state associated with cancer may be significantly altered by anticoagulation. Clinical trial information: NCT00476216.

Abstract 16415: Switching of ADP Receptor Inhibitor After Hospital Discharge Among Myocardial Infarction Patients: Insights From the TRANSLATE-ACS Observational Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marjorie E Zettler ◽  
Eric D Peterson ◽  
Lisa A McCoy ◽  
Mark B Effron ◽  
Kevin J Anstrom ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
First Year ◽  
Severe Bleeding ◽  
Bleeding Events ◽  
Post Discharge ◽  
Before And After ◽  
Adp Receptor

Background: With the availability of several ADP receptor inhibitors (ADPri), switching between agents is known to occur. However, among myocardial infarction (MI) patients treated with percutaneous coronary intervention (PCI), the incidence and patterns of post-discharge ADPri switching are unknown. Methods: Using data from the TRANSLATE-ACS study (2010-2012), we assessed the incidence of post-discharge ADPri switching among 8672 MI patients who were discharged after PCI and remained on ADPri therapy through 1 year post-MI. We examined bleeding and major adverse cardiovascular events (MACE: MI, stroke, unplanned revascularization) within 7 days before and after switching. Results: During the first year after index MI discharge, 663 patients (7.6%) had a switch in ADPri; switching occurred at a median of 50 days (IQR 7-154) post-discharge. Switching occurred most frequently in patients discharged on ticagrelor (64/226, 28.3%), then prasugrel (383/2489, 15.4%), and clopidogrel (216/5957, 3.6%, p<0.001). Among patients discharged on prasugrel, 97.3% of switches were to clopidogrel; 87.5% of ticagrelor switches were to clopidogrel. Among clopidogrel patients who switched, 55 (25.5%) had a MACE event in the 7 days preceding switch. Among prasugrel and ticagrelor patients who switched, a GUSTO moderate/severe bleeding event occurred in 5 (1.3%) and 1 (1.5%) patients, respectively, in the 7 days preceding switch. Patients switched from prasugrel or ticagrelor most often cited cost as a reason for the switch (43.6% and 39.1%, respectively), while 60.7% of patients switched from clopidogrel attributed the switch to a physician decision. In the week following a switch, both MACE and major bleeding events were infrequent (table). Conclusions: ADPri switching occurred infrequently within the first year post-MI. Switching occurred more commonly among patients discharged on higher potency ADPri, but only a minority of these switches were triggered by bleeding.

scholarly journals Suppression of gastric acid secretion decreased cardiovascular events independent of severe bleeding events in patients after percutaneous coronary intervention – sub-analysis from multicenter registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Kamishima ◽  
K Jujo ◽  
H Tanaka ◽  
T Hata ◽  
Y Ota ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acid Secretion ◽  
Gastric Acid Secretion ◽  
Cardiovascular Events ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Severe Bleeding ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Background Suppression of gastric acid secretion by proton-pump inhibitor (PPI) or potassium-competitive acid blocker (P-CAB) has recently been developed as a standard strategy for preventing gastrointestinal bleeding for patients receiving antiplatelet therapy after percutaneous coronary intervention (PCI). However, there has been limited evidences on the association between PPI/P-CAB administration and adverse cardiovascular events in patients undergoing PCI. Purpose We aimed to evaluate the prognostic impact of the prescription of PPI/P-CAB on clinical outcomes in patients after PCI. Methods This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent PCI at 12 hospitals in Japan between 2017 and 2019. Among registered patients, we ultimately evaluated 1,428 patients who were followed-up. They were divided into two groups by the prescriptions of PPI or P-CAB at discharge for the index PCI; the PPI/P-CAB group (n=1,023), and the Non-PPI/P-CAB group (n=407). The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) including death, acute coronary syndrome, stent thrombosis, hospitalization due to heart failure and ischemic stroke. Secondary endpoints was major bleeding events defined BARC3, 4 and 5. Results The average age of the study population was 70.3 years and 80.3% were male. Baseline clinical profiles were comparable between the groups, except that the PPI/P-CAB group included significantly higher rate of patients who had history of prior PCI (28.4% vs 18.7%, P=0.02). Additionally, there was no significant difference in the duration of dual antiplatelet therapy between the PPI/P-CAB group and Non-PPI/P-CAB group (average duration; 287±8 vs. 285±8 days, P=0.66). Overall, MACCE was developed in 132 patients (9.3%), and bleeding event was observed in 24 patients (1.7%) during 574 days of median follow-up period. Kaplan-Meier analysis showed that patients in the PPI/P-CAB group had a significantly lower rate of MACCE than those in the Non-PPI/P-CAB group (Log-rank test, p=0.0003, Figure 1A). Multivariate Cox regression analysis revealed that the prescription of PPI/P-CAB still was independently associated with the primary endpoint (hazard ratio 0.532, 95% confidence interval 0.369–0.766, p=0.0007), even after the adjustment by diverse covariates. Whereas, there was no significant difference in the bleeding event (p=0.64, Figure 1B). Conclusion PPI or P-CAB therapy was associated with better clinical outcomes after PCI, independent of the incidences of severe bleeding events. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Thrombotic vs. Bleeding Events of Interruption of Dual Antiplatelet Therapy within 12 Months among Patients with Stent-Driven High Ischemic Risk Definition following PCI

2022 ◽  
Vol 2022 ◽  
pp. 1-15
Author(s):  
Hao-Yu Wang ◽  
Bo Xu ◽  
Chen-Xi Song ◽  
Chang-Dong Guan ◽  
Li-Hua Xie ◽  
...  
Keyword(s):  
High Risk ◽  
Propensity Score ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Dual Antiplatelet Therapy ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Bleeding Events ◽  
Risk Criteria ◽  
Clinical Events

Background. There is a paucity of real-world data regarding the clinical impact of dual antiplatelet therapy (DAPT) interruption (temporary or permanent) among patients at high ischemic risk. The aim of this study was to assess the risk of cardiovascular events after interruption of DAPT in high-risk PCI population. Methods. This study used data from the Fuwai PCI registry, a large, prospective cohort of consecutive patients who underwent PCI. We assessed 3,931 patients with at least 1 high ischemic risk criteria of stent-related recurrent ischemic events proposed in the 2017 ESC guidelines for focused update on DAPT who were free of major cardiac events in the first 12 months. The primary ischemic endpoint was 30-month major adverse cardiac and cerebrovascular events, and the key safety endpoints were BARC class 2, 3, or 5 bleeding and net adverse clinical events. Results. DAPT interruption within 12 months occurred in 1,122 patients (28.5%), most of which were due to bleeding events or patients’ noncompliance to treatment. A multivariate Cox regression model, propensity score (PS) matching, and inverse probability of treatment weighting (IPTW) based on the propensity score demonstrated that DAPT interruption significantly increased the risk of primary ischemic endpoint compared with prolonged DAPT (3.9% vs. 2.2%; Cox-adjusted hazard ratio (HR): 1.840; 95% confidence interval (CI): 1.247 to 2.716; PS matching-HR: 2.049 [1.236–3.399]; IPTW-adjusted HR: 1.843 [1.250–2.717]). This difference was driven mainly by all-cause death (1.8% vs. 0.7%) and MI (1.3% vs. 0.5%). Furthermore, the rate of net adverse clinical events (4.9% vs. 3.2%; Cox-adjusted HR: 1.581 [1.128–2.216]; PS matching-HR: 1.639 [1.075–2.499]; IPTW-adjusted HR: 1.554 [1.110–2.177]) was also higher in patients with DAPT interruption (≤12 months), whereas no significant differences between groups were observed in terms of BARC 2, 3, or 5 bleeding. These findings were consistent across various stent-driven high-ischemic risk subsets with respect to the primary ischemic endpoints, with a greater magnitude of harm among patients with diffuse multivessel diabetic coronary artery disease. Conclusions. In patients undergoing high-risk PCI, interruption of DAPT in the first 12 months occurred infrequently and was associated with a significantly higher adjusted risk of major adverse cardiovascular events and net adverse clinical events. 2017 ESC stent-driven high ischemic risk criteria may help clinicians to discriminate patient selection in the use of long-term DAPT when the ischemic risk certainly overcomes the bleeding one.

Efficacy and safety of aspirin for cardiovascular risk prevention in younger and older age: an updated systematic review and meta-analysis

2021 ◽  
Author(s):  
Dario Calderone ◽  
Antonio Greco ◽  
Salvatore Ingala ◽  
Federica Agnello ◽  
Antonio Gabriele Franchina ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Older Individuals ◽  
Efficacy And Safety ◽  
Safety Outcome ◽  
Increased Risk

Aims - The efficacy and safety of aspirin for primary cardiovascular disease (CVD) prevention is controversial. The aim of this study was to investigate the merits of aspirin in subjects with no overt CVD, with a focus on age as a treatment modifier. Methods and results - Randomized trials comparing aspirin use versus no aspirin use or placebo were included. The primary efficacy outcome was all-cause death. The primary safety outcome was major bleeding. Subgroups analyses were conducted to investigate the consistency of the effect sizes in studies including younger and older individuals, using a cut-off of 65 years. A total of 21 randomized trials including 173,810 individuals at a mean follow-up of 5.3 years were included. Compared with control, aspirin did not reduce significantly the risk of all-cause death (risk ratio 0.96, 95% CI 0.92-1.00, p=0.057). Major adverse cardiovascular events were significantly reduced by 11%, paralleled by significant reductions in myocardial infarction and transient ischemic attack. Major bleeding, intracranial hemorrhage, and gastrointestinal bleeding were significantly increased by aspirin. There was a significant age interaction for death (p for interaction=0.007), with aspirin showing a statistically significant 7% relative benefit on all-cause death in studies including younger patients. Conclusions - The use of aspirin in subjects with no overt cardiovascular disease was associated with a neutral effect on all-cause death and a modest lower risk of major cardiovascular events at the price of an increased risk in major bleeding. The benefit of aspirin might be more pronounced in younger individuals.

scholarly journals Substantially elevated thromboembolic and bleeding risks in patients with AMI following acute/subacute stroke events

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Kataoka ◽  
T Iwai ◽  
K Sawada ◽  
H Matama ◽  
S Honda ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Current Guideline ◽  
Primary Pci ◽  
Bleeding Events ◽  
Real World Data ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Major Bleeding Events

Abstract Introduction AMI infrequently but concomitantly occurs after stroke events. Current guideline recommends primary PCI with DAPT in the setting of AMI. However, this approach is not necessarily applicable in AMI subjects following acute/subacute stroke events due to its bleeding risk. Clinical management and outcomes of these AMI subjects following remains uncertain. Purpose To characterize management and clinical outcomes in patients with AMI following acute/subacute stroke events (=post-stroke AMI). Methods The current study retrospectively analyzed 2041 AMI patients hospitalized at our institute from 2007 to 2018. Post-stroke AMI was defined as its occurrence within 14 days after ischemic/hemorrhagic stroke. The use of reperfusion and anti-thrombotic therapies, and the occurrence of major adverse cardiovascular events (=CV death, non-fatal MI and non-fatal stroke) and major bleeding events (BARC type 3 or 5) were compared in post-stroke and non-post-stroke AMI patients. Results Post-stroke AMI was identified in 1.1% of entire subjects (=23/2041). Of these, 65% of them (=15/23) had AMI within 3 days from the onset of stoke event. Over 60% of them was due to cardioembolic stroke, followed by hemorrhagic (9%), atherothrombotic ones (8%) and other causes (22%). Post-stroke AMI patients were more likely to exhibit Af (p=0.02) and a history of hemodialysis (p=0.009), and have a lower BMI (p=0.04) and hemoglobin level (p=0.02). They were less likely to receive emergent coronary angiography, and primary PCI was conducted in only 65% of post-stroke AMI patients (Table). Furthermore, they more frequently received thrombectomy (p=0.04) alone rather than stent implantation (p=0.002) (Table). With regard to anti-thrombotic therapy, the proportion of DAPT use was significantly lower in post-stroke AMI subjects (52 vs. 89%, p=0.0001), and 17% of them did not receive any anti-thrombotic agents. Of note, only 48% (p=0.04) and 43% (p=0.0001) of post-stroke AMI patients were treated with other established medical therapies including β-blocker and statin, respectively. During the observational period (median = 2.9 years), post-stroke AMI was associated with a greater likelihood experiencing major adverse cardiovascular events (log-rank p&lt;0.001, Figure), CV death (log-rank p&lt;0.0001) and stroke events (log-rank p&lt;0.0001). Furthermore, the frequency of their major bleeding events was substantially elevated (log-rank p&lt;0.001, Figure). Conclusions In our real-world data, the adoption of guideline-recommended reperfusion and anti-thrombotic therapies were considerably low in AMI subjects following acute/subacute stroke events. Given their elevated risk of cardiovascular and bleeding events, it is required to establish better therapeutic management for mitigating their thrombotic/bleeding risks. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

P2553Combined with ticagrelor, 50 mg aspirin daily can reduce bleeding events without increasing ischaemic risk compared with 75–100 mg aspirin daily in coronary artery disease patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Li
Keyword(s):  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
P Value ◽  
Severe Bleeding ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Risk Of Bleeding ◽  
Dose Aspirin ◽  
Hs Crp ◽  
Artery Disease

Abstract Aim To investigate the efficacy and safety of ticagrelor combined with a lower dose of aspirin than that recommended by guidelines. Methods Hospitalized patients received ticagrelor (90 mg twice daily) plus aspirin (50–100 mg/day) for up to 12 months. The rates of major adverse cardiovascular events (MACEs), bleeding events and ticagrelor adherence were compared among the groups treated with 50 mg and 75–100 mg aspirin. Results MACE risk was not significantly different between the two groups (OR=0.829, 95% CI: 0.279–2.461, P=0.736). However, 75–100 mg aspirin was associated with a greater risk of bleeding events (OR=1.524, 95% CI: 1.082–2.146, P=0.016), particularly mild and moderate bleeding events (OR=1.480, 95% CI: 1.047–2.092, P=0.026). Moreover, lower-dose aspirin was associated with a lower rate of ticagrelor withdrawal (OR=1.850, 95% CI: 1.025–3.339, P=0.041), mainly because of the decrease in ticagrelor withdrawal due to bleeding (OR=4.565, 95% CI: 1.081–19.270, P=0.039). MACEs and bleeding events within 1 year Endpoint 75–100 mg (n=744) 50 mg (n=188) Unadjusted (95% CI) P value Adjusted# (95% CI) P value MACEs 18 (2.4) 4 (2.1) 0.876 (0.296–2.588) * 0.876 0.829 (0.279–2.461)* 0.736 Bleeding 311 (41.8) 60 (31.9) 1.532 (1.091–2.152)** 0.014 1.524 (1.082–2.146)** 0.016 Severe bleeding 14 (1.9) 2 (1.1) 1.784 (0.402–7.916)** 0.447 1.807 (0.405–8.069)** 0.438 Mild bleeding 297 (39.9) 58 (30.8) 1.489 (1.057–2.098)** 0.023 1.480 (1.047–2.092)** 0.026 #Adjusted for age, sex, LDL-C, hs-CRP, diabetes mellitus, hypertension, hyperlipidaemia and MI history. *Hazard ratio (high vs low); **Odds ratio (high vs low). Conclusion Among patients who took ticagrelor (90 mg twice daily), 50 mg aspirin daily is associated with a lower rate of bleeding events and ticagrelor withdrawal but does not increase the MACE risk compared with 75–100 mg aspirin daily. Acknowledgement/Funding The study was supported by AstraZeneca's fund for the TIFU study (ESR-15-11199).

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