Ticagrelor-based antiplatelet regimens in patients with atherosclerotic artery disease - a meta-analysis of randomized clinical trials

Publication date: Available online 31 August 2019Source: American Heart JournalAuthor(s): Salvatore Cassese, Gjin Ndrepepa, Robert A. Byrne, Karl-Ludwig Laugwitz, Heribert Schunkert, Massimiliano Fusaro, Fernando Alfonso, Adnan KastratiAbstractBackgroundRandomized trials did not consistently support superiority of ticagrelor, as monotherapy or in combination with aspirin, in terms of efficacy or safety, in patients with atherosclerotic artery disease.MethodsMedline, EMBASE, the Cochrane Central Register of Controlled Trials and scientific session abstracts were searched for trials of patients with coronary or peripheral artery disease (with>1000 participants and a follow-up ≥3 months) randomly assigned to ticagrelor-based or conventional antiplatelet therapies. Trial-level hazard ratios were pooled using a fixed or random effect model (in case of significant heterogeneity) with the inverse variance weighting. The primary outcome was all-cause mortality. Other outcomes were myocardial infarction (MI), stroke and major bleeding.ResultsOverall 77,489 patients received either ticagrelor-based (n = 38,721) or conventional antiplatelet regimens (n = 38,768) in six trials. The primary outcome occurred in 4.5% of patients treated with experimental therapy and 4.9% of patients treated with control therapy (hazard ratio [HR] = 0.91, 95% confidence interval [CI] 0.81 to 1.01; P = .07). Overall, patients treated with ticagrelor-based ver...
Source: American Heart Journal - Category: Cardiology Source Type: research

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Publication date: January 2020Source: American Heart Journal, Volume 219Author(s): Salvatore Cassese, Gjin Ndrepepa, Robert A. Byrne, Karl-Ludwig Laugwitz, Heribert Schunkert, Massimiliano Fusaro, Fernando Alfonso, Adnan KastratiBackgroundRandomized trials did not consistently support superiority of ticagrelor, as monotherapy or in combination with aspirin, in terms of efficacy or safety, in patients with atherosclerotic artery disease.MethodsMedline, EMBASE, the Cochrane Central Register of Controlled Trials, and scientific session abstracts were searched for trials of patients with coronary or peripheral artery disease (...
Source: American Heart Journal - Category: Cardiology Source Type: research
AbstractDirect oral anticoagulants (DOACs) include dabigatran, which inhibits thrombin, and apixaban, edoxaban, and rivaroxaban, which inhibit factor Xa. They have been extensively studied in large trials involving patients affected by the most common cardiovascular diseases. As the presence of diabetes leads to peculiar changes in primary and secondary hemostasis, in this review we highlight the current evidence regarding DOAC use in diabetic patients included in the majority of recently conducted studies. Overall, in trials involving patients with atrial fibrillation, data seem to confirm at least a similar efficacy and ...
Source: Acta Diabetologica - Category: Endocrinology Source Type: research
CONCLUSION: In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis. PMID: 31596707 [PubMed - in process]
Source: The Heart Surgery Forum - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Heart Surg Forum Source Type: research
Abstract BACKGROUND: Patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD) and history of heart failure (HF) are at high risk for major adverse cardiovascular events (MACE). We explored the effects of rivaroxaban with or without aspirin in these patients. METHODS: The COMPASS trial randomized 27,395 participants with chronic CAD or PAD to rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily, rivaroxaban 5 mg twice daily alone, or aspirin 100 mg alone. Patients with NYHA class III or IV HF or left ventricular ejection fraction (EF)
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
Abstract Aspirin decreases the risk of recurrent thrombotic events in patients with coronary artery disease or peripheral artery disease but the risk of recurrent events remains high. Long term dual antiplatelet therapy or the combination of aspirin and warfarin further reduces the risk of recurrent events, but at the cost of increased bleeding and neither of these treatments reduce mortality. The Cardiovascular OutcoMes in People using Anticoagulation StrategieS randomised controlled trial involving 27,395 patients from 602 sites in 33 countries (Poland: 9 sites, 518 patients) tested whether low-dose anticoagulan...
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
Update In March 2019, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines that suggest that most adults without a history of heart disease should not take low-dose daily aspirin to prevent a first heart attack or stroke. Based on the ASPREE, ARRIVE, and ASCEND trials, the ACC/AHA guidelines concluded that the risk of side effects from aspirin, particularly bleeding, outweighed the potential benefit. The new guidelines do not pertain to people with established cardiovascular disease, in whom the benefits of daily aspirin have been found to outweigh the risks. ___________...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Heart Health Prevention Source Type: blogs
Abstract Oral anticoagulants (OAC) are widely used for prevention of systemic thromboembolism, including the reduction of the risk of stroke in patients with atrial fibrillation (AF) and prosthetic heart valves. There is also an increasing population of patients who require not only OACs, but also double antiplatelet therapy (DAPT). A typical example is a patient with AF and stable coronary artery disease or acute coronary syndrome (ACS), treated by percutaneous coronary intervention (PCI). In recent years, with the introduction of NOACs, triple or dual therapy has become safer. Regardless of these indications for...
Source: Polish Heart Journal - Category: Cardiology Authors: Tags: Kardiol Pol Source Type: research
Well, it seems as though not even a week can go by without more data on aspirin! I recently reviewed the ARRIVE trial and the implications for primary prevention — that is, trying to prevent heart attacks and strokes in otherwise healthy people. Since then, yet another large clinical trial — the ASPREE study — has come out questioning the use of aspirin in primary prevention. Three articles pertaining to this trial were published in the prestigious New England Journal of Medicine, which is an unusual degree of coverage for one trial and highlights its immediate relevance to clinical practice. Aspirin stil...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Heart Health Prevention Source Type: blogs
CONCLUSIONS: Overall, results of secondary analyses indicate that the recommended dosing strategy for each of the DOACs produces a consistent anticoagulant effect across a diverse patient population, including those at increased risk of stroke or bleeding. PMID: 30081727 [PubMed - in process]
Source: Adv Data - Category: Epidemiology Authors: Tags: Ther Adv Cardiovasc Dis Source Type: research
Abstract OBJECTIVES: Few data are available on the association between a different entity of platelet inhibition on antiplatelet treatment and clinical outcomes in patients with peripheral artery disease (PAD). The aim of this study was to evaluate the degree of on-treatment platelet reactivity, and its association with ischaemic and haemorrhagic adverse events at follow up in PAD patients undergoing percutaneous transluminal angioplasty (PTA). METHODS: In this observational, prospective, single centre study, 177 consecutive patients with PAD undergoing PTA were enrolled, and treated with dual antiplatelet th...
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
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