coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2014 Dec 4;371(23):2155-66 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
dual antiplatelet therapy (aspirin + P2Y12 inhibitor (clopidogrel or prasugrel)) for 30 months
As Treatment, Chronic
Is worse Than
dual antiplatelet therapy (aspirin + thienopyridine) for 12 months only
To improve all-cause mortality (2.0% 30 months VS 1.5% 12 months), even if it reduced cardiovascular events (4.3% 30 months VS 5.9% 12 months). Extended treatment increased major bleedings (2.5% vs 1.6%) but that did not explain the mortality difference
N Engl J Med. 2015 May 07;372(19):1791-800 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
mantaining dual antiplatelet after 1 year with ticagrelor (90 mg twice daily or 60 mg twice daily) plus low-dose aspirin
As Treatment, Chronic
Is better Than
placebo plus low-dose aspirin
To reduce cardiovascular events (8% both doses ticagrelor VS 9% aspirin alone) but increasing major bleeding (2.5% ticagrelor VS 1% aspirin alone)
J Am Coll Cardiol. 2015 Mar 24;65(11):1092-102 Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
short- (≤6 months) dual antiplatelet therapy
As Treatment, Chronic
Is better Than
long-term (1 year) dual antiplatelet therapy
To reduce bleeding (HR 0.66) while achieving similar rates of cardiac events (cardiac death, myocardial infarction, or definite/probable stent thrombosis: HR 1.11)
BMJ. 2015 Apr 16;350:h1618 Meta-Analysis
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
short term course of dual antiplatelet therapy
As Treatment, Chronic
Is better Than
12 month dual antiplatelet therapy
To reduce major bleeding (OR 0.58) with no significant differences in ischaemic or thrombotic outcomes. Extended VS 12 month Tt yielded a reduction of ischemic events (OR 0.33 to 0.53) but more major bleeding (OR 1.66) and more all-cause deaths (OR 1.30)
N Engl J Med. 2017 Oct 19;377(16):1513-1524 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with dabigatran 110 mg twice daily plus an a P2Y12inhibitor (clopidogrel or ticagrelor) antiplatelet
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet
To reduce at 14 months major or clinically relevant bleeding events (15% dabigatran 110mg VS 27% triple therapy) with no increase of cardiovascular events (13.7% dual-therapy VS 13.4% triple-therapy)
Lancet. 2013 Mar 30;381(9872):1107-15 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with INR adjusted warfarin plus clopidogrel
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet (aspirin + clopidogrel)
To reduce at 1 year any bleeding event (19% dual Tt VS 44% triple Tt) with no increase in the rate of thrombotic events
N Engl J Med. 2016 Dec 22;375(25):2423-2434 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
low-dose rivaroxaban (15 mg /d) plus an P2Y12 inhibitor antiplatelet for 12 months OR very-low-dose rivaroxaban (2.5 mg twice daily) plus dual antiplatelet for 1, 6, or 12 months
As Treatment, Chronic
Is better Than
dose-adjusted vitamin K antagonist plus dual antiplatelet for 1, 6, or 12 months
To reduce clinically significant bleeding (17% rivaroxaban 15 + 1 antiplatelet, 18% rivaroxaban 2.5 + 2 antiplatelets, and 26.7% antivitamin K + 2 antiplatelets) while having similar rates of cardiovascular events (6.5%, 5.6% and 6% respectively)