Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation
| Autor: | Johanne SILVAIN, Sotir Marchev, Frans Van de Werf, Juhani Airaksinen, Ru San Tan, Daniel Duerschmied, Bela Merkely, Rolf Wachter, Bassem A. Samad, Philippe Gabriel STEG, Dirk Westermann, Didier CARRIE, Fernando Lanas, MICHELE SENNI, José Ramón Rumoroso, Wanwarang Wongcharoen, Grzegorz Opolski, Niall Mahon, Sandro Brusich |
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| Přispěvatelé: | Clinical sciences, Cardiology |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Ticagrelor Adenosine Platelet Aggregation Inhibitors/therapeutic use 030204 cardiovascular system & hematology 0302 clinical medicine Hemorrhage/chemically induced Atrial Fibrillation Medicine Cardiac and Cardiovascular Systems 030212 general & internal medicine Stroke risk Kardiologi Incidence Research Support Non-U.S. Gov't General Medicine Middle Aged Clopidogrel Dabigatran Multicenter Study Drug Therapy Combination/adverse effects Randomized Controlled Trial Purinergic P2Y Receptor Antagonists/adverse effects Cardiology Platelet aggregation inhibitor Drug Therapy Combination Female Anticoagulants/adverse effects Cardiology and Cardiovascular Medicine medicine.drug Risk medicine.medical_specialty Ticlopidine Hemorrhage Warfarin/adverse effects Ticlopidine/analogs & derivatives 03 medical and health sciences Percutaneous Coronary Intervention Internal medicine Adenosine/adverse effects Journal Article Humans cardiovascular diseases Dabigatran/adverse effects Aged clopidogrel Aspirin business.industry Atrial Fibrillation/drug therapy percutaneous coronary intervention Warfarin Anticoagulants ta3121 medicine.disease Conventional PCI Aspirin/therapeutic use Purinergic P2Y Receptor Antagonists incidence business Platelet Aggregation Inhibitors |
| Zdroj: | Cannon, C P, Bhatt, D L, Oldgren, J, Lip, G Y H, Ellis, S G, Maeng, M, Merkely, B, Manassie, J, Januzzi, J L, Ten Berg, J M, Steg, P G, Hohnloser, S H & RE-DUAL PCI Steering Committee and Investigators 2017, ' Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation ', The New England Journal of Medicine, vol. 377, no. 16, pp. 1513-1524 . https://doi.org/10.1056/NEJMoa1708454 |
| DOI: | 10.1056/NEJMoa1708454 |
| Popis: | BACKGROUND: Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding.METHODS: In this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups). Outside the United States, elderly patients (≥80 years of age; ≥70 years of age in Japan) were randomly assigned to the 110-mg dual-therapy group or the triple-therapy group. The primary end point was a major or clinically relevant nonmajor bleeding event during follow-up (mean follow-up, 14 months). The trial also tested for the noninferiority of dual therapy with dabigatran (both doses combined) to triple therapy with warfarin with respect to the incidence of a composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization.RESULTS: The incidence of the primary end point was 15.4% in the 110-mg dual-therapy group as compared with 26.9% in the triple-therapy group (hazard ratio, 0.52; 95% confidence interval [CI], 0.42 to 0.63; PCONCLUSIONS: Among patients with atrial fibrillation who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with dabigatran and a P2Y12 inhibitor than among those who received triple therapy with warfarin, a P2Y12 inhibitor, and aspirin. Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events. (Funded by Boehringer Ingelheim; RE-DUAL PCI ClinicalTrials.gov number, NCT02164864 .). |
| Databáze: | OpenAIRE |
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