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Aspirin Dosing for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Patients Treated With P2Y12 Inhibitors.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2023 Oct 17; Vol. 12 (20), pp. e030385. Date of Electronic Publication: 2023 Oct 13. - Publication Year :
- 2023
-
Abstract
- Background The ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) was a large, pragmatic, randomized controlled trial that found no difference between high- versus low-dose aspirin for secondary prevention of atherosclerotic cardiovascular disease. Whether concomitant P2Y12 inhibitor therapy modifies the effect of aspirin dose on clinical events remains unclear. Methods and Results Participants in ADAPTABLE were stratified according to baseline use of clopidogrel or prasugrel (P2Y12 group). The primary effectiveness end point was a composite of death, myocardial infarction, or stroke; and the primary safety end point was major bleeding requiring blood transfusions. We used multivariable Cox regression to compare the relative effectiveness and safety of aspirin dose within P2Y12 and non-P2Y12 groups. Of 13 815 (91.6%) participants with available data, 3051 (22.1%) were receiving clopidogrel (2849 [93.4%]) or prasugrel (203 [6.7%]) at baseline. P2Y12 inhibitor use was associated with higher risk of the primary effectiveness end point (10.86% versus 6.31%; adjusted hazard ratio [HR], 1.40 [95% CI, 1.22-1.62]) but was not associated with bleeding (0.95% versus 0.53%; adjusted HR, 1.42 [95% CI, 0.91-2.22]). We found no interaction in the relative effectiveness and safety of high- versus low-dose aspirin by P2Y12 inhibitor use. Overall, dose switching or discontinuation was more common in the high-dose compared with low-dose aspirin group, but the pattern was not modified by P2Y12 inhibitor use. Conclusions In this prespecified analysis of ADAPTABLE, we found that the relative effectiveness and safety of high- versus low-dose aspirin was not modified by baseline P2Y12 inhibitor use. Registration https://www.clinical.trials.gov. Unique identifier: NCT02697916.
- Subjects :
- Humans
Clopidogrel adverse effects
Platelet Aggregation Inhibitors therapeutic use
Prasugrel Hydrochloride adverse effects
Ticlopidine therapeutic use
Secondary Prevention
Purinergic P2Y Receptor Antagonists therapeutic use
Aspirin therapeutic use
Hemorrhage chemically induced
Cardiovascular Diseases diagnosis
Cardiovascular Diseases prevention & control
Cardiovascular Diseases chemically induced
Acute Coronary Syndrome drug therapy
Atherosclerosis diagnosis
Atherosclerosis drug therapy
Atherosclerosis prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 12
- Issue :
- 20
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 37830344
- Full Text :
- https://doi.org/10.1161/JAHA.123.030385