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Title: | Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk | Authors: | Valgimigli, Marco Frigoli, Enrico Heg, Dik Tijssen, Jan Juni, Peter VRANCKX, Pascal Ozaki, Yukio Morice, Marie-Claude Chevalier, Bernard Onuma, Yoshinobu Windecker, Stephan Tonino, Pim A. L. Roffi, Marco Lesiak, Maciej Mahfoud, Felix Bartunek, Jozef Hildick-Smith, David Colombo, Antonio Stankovic, Goran Iniguez, Andres Schultz, Carl Kornowski, Ran Ong, Paul J. L. Alasnag, Mirvat Rodriguez, Alfredo E. Moschovitis, Aris Laanmets, Peep Donahue, Michael Leonardi, Sergio Smits, Pieter C. |
Issue Date: | 2021 | Publisher: | MASSACHUSETTS MEDICAL SOC | Source: | The New England journal of medicine (Print), 385 (18) , p. 1643-1655 | Abstract: | BACKGROUND The appropriate duration of dual antiplatelet therapy in patients at high risk for bleeding after the implantation of a drug-eluting coronary stent remains unclear. METHODS One month after they had undergone implantation of a biodegradable-polymer sirolimus-eluting coronary stent, we randomly assigned patients at high bleeding risk to discontinue dual antiplatelet therapy immediately (abbreviated therapy) or to continue it for at least 2 additional months (standard therapy). The three ranked primary outcomes were net adverse clinical events (a composite of death from any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (a composite of death from any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding; cumulative incidences were assessed at 335 days. The first two outcomes were assessed for noninferiority in the per-protocol population, and the third outcome for superiority in the intention-to-treat population. RESULTS Among the 4434 patients in the per-protocol population, net adverse clinical events occurred in 165 patients (7.5%) in the abbreviated-therapy group and in 172 (7.7%) in the standard-therapy group (difference, -0.23 percentage points; 95% confidence interval [CI], -1.80 to 1.33; P<0.001 for noninferiority). A total of 133 patients (6.1%) in the abbreviated-therapy group and 132 patients (5.9%) in the standard-therapy group had a major adverse cardiac or cerebral event (difference, 0.11 percentage points; 95% CI, -1.29 to 1.51; P=0.001 for noninferiority). Among the 4579 patients in the intention-to-treat population, major or clinically relevant nonmajor bleeding occurred in 148 patients (6.5%) in the abbreviated-therapy group and in 211 (9.4%) in the standard-therapy group (difference, -2.82 percentage points; 95% CI, -4.40 to -1.24; P<0.001 for superiority). CONCLUSIONS One month of dual antiplatelet therapy was noninferior to the continuation of therapy for at least 2 additional months with regard to the occurrence of net adverse clinical events and major adverse cardiac or cerebral events; abbreviated therapy also resulted in a lower incidence of major or clinically relevant nonmajor bleeding. | Notes: | Valgimigli, M (corresponding author), Univ Svizzera Italiana, Cardioctr Ticino Inst, Ente Osped Cantonale, Via Tesserete 48, CH-6900 Lugano, Switzerland. marco.valgimigli@eoc.ch |
Document URI: | http://hdl.handle.net/1942/34846 | ISSN: | 0028-4793 | e-ISSN: | 1533-4406 | DOI: | 10.1056/NEJMoa2108749 | ISI #: | 000691646500001 | Rights: | 2021 Massachusetts Medical Society. All rights reserved. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2022 |
Appears in Collections: | Research publications |
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