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Cost ‐effectiveness analysis of 30‐month vs 12‐month dual antiplatelet therapy with clopidogrel and aspirin after drug‐eluting stents in patients with acute coronary syndrome
Continuation of dual antiplatelet therapy (DAPT) beyond 1 year reduces late stent thrombosis and ischemic events after drug‐eluting stents (DES) but increases risk of bleeding. We hypothesized that extending DAPT from 12 months to 30 months in patients with acute coronary syndrome (ACS) after DES is cost‐effective. A lifelong decision‐analytic model was designed to simulate 2 antiplatelet strategies in event‐free ACS patients who had completed 12‐month DAPT after DES: aspirin monotherapy (75–162 mg daily) and continuation of DAPT (clopidogrel 75 mg daily plus aspirin 75–162 mg daily) for 18 months. Clinical e...
Source: Clinical Cardiology - June 1, 2017 Category: Cardiology Authors: Minghuan Jiang, Joyce H.S. You Tags: QUALITY AND OUTCOMES Source Type: research

Oral anticoagulation management in patients with atrial fibrillation undergoing cardiac implantable electronic device implantation
ConclusionsManagement of anticoagulation among AF patients undergoing CIED implantation is highly variable, with OAC being interrupted in more than half of both warfarin‐ and NOAC‐treated patients. Bleeding and stroke events were infrequent in both warfarin and NOAC‐treated patients.
Source: Clinical Cardiology - May 1, 2017 Category: Cardiology Authors: Eric Black ‐Maier, Sunghee Kim, Benjamin A. Steinberg, Gregg C. Fonarow, James V. Freeman, Peter R. Kowey, Jack Ansell, Bernard J. Gersh, Kenneth W. Mahaffey, Gerald Naccarelli, Elaine M. Hylek, Alan S. Go, Eric D. Peterson, Jonathan P. Piccini, Tags: CLINICAL INVESTIGATIONS Source Type: research

Design and Rationale of the RE ‐DUAL PCI Trial: A Prospective, Randomized, Phase 3b Study Comparing the Safety and Efficacy of Dual Antithrombotic Therapy With Dabigatran Etexilate Versus Warfarin Triple Therapy in Patients With Nonvalvular Atrial Fibrillation Who Have Undergone Percutaneous Coronary Intervention With Stenting
Antithrombotic management of patients with atrial fibrillation (AF) undergoing coronary stenting is complicated by the need for anticoagulant therapy for stroke prevention and dual antiplatelet therapy for prevention of stent thrombosis and coronary events. Triple antithrombotic therapy, typically comprising warfarin, aspirin, and clopidogrel, is associated with a high risk of bleeding. A modest‐sized trial of oral anticoagulation with warfarin and clopidogrel without aspirin showed improvements in both bleeding and thrombotic events compared with triple therapy, but large trials are lacking. The RE‐DUAL PCI trial (NCT...
Source: Clinical Cardiology - July 31, 2016 Category: Cardiology Authors: Christopher P. Cannon, Savion Gropper, Deepak L. Bhatt, Stephen G. Ellis, Takeshi Kimura, Gregory Y.H. Lip, Ph. Gabriel Steg, Jurri ën M. Berg, Jenny Manassie, Jörg Kreuzer, Jon Blatchford, Joseph M. Massaro, Martina Brueckmann, Ernesto Ferreiros Ripoll Tags: Trial Designs Source Type: research

Dual Antiplatelet Therapy and Outcomes in Patients With Atrial Fibrillation and Acute Coronary Syndromes Managed Medically Without Revascularization: Insights From the TRILOGY ACS Trial
We examined these associations for medically managed ACS patients randomized to dual antiplatelet therapy (DAPT) using patient data from the TRILOGY ACS trial. DAPT included aspirin plus clopidogrel 75 mg/d or prasugrel 10 mg/d (5 mg/d for those <60 kg or age ≥75 years). Patients receiving oral anticoagulants were excluded. Cox proportional hazards regression modeling was used to characterize associations between patients with AF (AF+) vs those without (AF−) and risk of ischemic and bleeding events, and to explore effects of randomized treatment on outcomes. Among 9101 patients with baseline AF status, 710...
Source: Clinical Cardiology - June 30, 2016 Category: Cardiology Authors: Larry R. Jackson, Jonathan P. Piccini, Derek D. Cyr, Matthew T. Roe, Megan L. Neely, Felipe Martinez, Thomas F. L üscher, Renato D. Lopes, Kenneth J. Winters, Harvey D. White, Paul W. Armstrong, Keith A.A. Fox, Dorairaj Prabhakaran, Deepak L. Bhatt, E. M Tags: Clinical Trial Updates Source Type: research

Clinical Outcome of First‐ vs Second‐Generation DES According to DAPT Duration: Results of ARCTIC‐Generation
ABSTRACT There is an apparent benefit with extension of dual antiplatelet therapy (DAPT) beyond 1 year after implantation of drug‐eluting stents (DES). Assessment by a Double Randomization of a Conventional Antiplatelet Strategy vs a Monitoring‐Guided Strategy for Drug‐Eluting Stent Implantation, and of Treatment Interruption vs Continuation One Year After Stenting (ARCTIC)‐Generation assessed whether there is a difference of outcome between first‐ vs second‐generation DES and if there is an interaction with DAPT duration in the ARCTIC‐Interruption study. ARCTIC‐Interruption randomly allocated 1259 patients...
Source: Clinical Cardiology - February 16, 2016 Category: Cardiology Authors: Jean‐Philippe Collet, Johanne Silvain, Mathieu Kerneis, Thomas Cuisset, Nicolas Meneveau, Ziad Boueri, Olivier Barthélémy, Grégoire Rangé, Guillaume Cayla, Eric Van Belle, Simon Elhadad, Didier Carrié, Christophe Caussin, Hélène Rousseau, Pierre Tags: Clinical Trial Updates Source Type: research

Antithrombotic Regimens for Patients Taking Oral Anticoagulation After Coronary Intervention: A Meta‐analysis of 16 Clinical Trials and 9185 Patients
This study sought to compare efficacy and safety outcomes of triple therapy (OAC, aspirin, and clopidogrel) vs dual therapy (clopidogrel with aspirin or OAC) in these patients. We hypothesize OAC plus clopidogrel could be the optimal regimen for patients with indications for OAC receiving stent implantation. Medline, the Cochrane Library, and other Internet sources were searched for clinical trials comparing the efficacy and safety of triple vs dual therapy for patients taking OAC after coronary stenting. Sixteen eligible trials including 9185 patients were identified. The risks of major adverse cardiac events (odds ratio ...
Source: Clinical Cardiology - May 12, 2015 Category: Cardiology Authors: Xiao‐Fei Gao, Yan Chen, Zhong‐Guo Fan, Xiao‐Min Jiang, Zhi‐Mei Wang, Bing Li, Wen‐Xing Mao, Jun‐Jie Zhang, Shao‐Liang Chen Tags: Reviews Source Type: research

One‐Year Outcome of Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting: An Analysis of the AFCAS Registry
ConclusionsIn this large, real‐world population of AF patients undergoing PCI‐S, TT was the antithrombotic regimen most frequently prescribed. Although several limitations need to be acknowledged, in our study the 1‐year efficacy and safety of TT, dual antiplatelet therapy, and VKA plus clopidogrel was comparable.
Source: Clinical Cardiology - January 30, 2014 Category: Cardiology Authors: Andrea Rubboli, Axel Schlitt, Tuomas Kiviniemi, Fausto Biancari, Pasi P. Karjalainen, Josè Valencia, Mika Laine, Paulus Kirchhof, Matti Niemelä, Saila Vikman, Gregory Y. H. Lip, K. E. Juhani Airaksinen, Tags: Clinical Investigations Source Type: research

New Antithrombotics for Secondary Prevention of Acute Coronary Syndrome
This study was terminated early in patients with prior stroke owing to excess ICH, though an increased risk of ICH or fatal bleeding was not detected in patients with prior myocardial infarction. The Apixaban for Prevention of Acute Ischemic and Safety Events 2 (APPRAISE‐2) trial of standard‐dose apixaban added to standard care in patients with ACS was also stopped early owing to excess serious bleeding. However, in Rivaroxaban in Combination With Aspirin Alone or With Aspirin and a Thienopyridine in Patients With Acute Coronary Syndromes (ATLAS ACS 2 TIMI 51), fatal bleeding or fatal ICH did not increase with low‐do...
Source: Clinical Cardiology - January 22, 2014 Category: Cardiology Authors: Shinya Goto, Aiko Tomita Tags: Review Source Type: research

Triple Oral Antithrombotic Therapy in Atrial Fibrillation and Coronary Artery Stenting
Patients with atrial fibrillation affected by an acute coronary syndrome have indications for oral anticoagulation and dual antiplatelet therapy with aspirin and a P2Y12 adenosine diphosphate receptor inhibitor after coronary artery stenting. The concurrent use of all 3 agents, termed triple oral antithrombotic therapy, significantly increases the risk of bleeding. To date, there is a lack of evidence on the proper combination and duration of anticoagulant and antiplatelet agents in patients with indications for both therapies. As such, care has been guided by expert opinion, and there is wide variation in clinician practi...
Source: Clinical Cardiology - July 1, 2013 Category: Cardiology Authors: Grant W. Reed, Christopher P. Cannon Tags: Review Source Type: research