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Relationship of Pla...
Relationship of Platelet Reactivity With Bleeding Outcomes During Long-Term Treatment With Dual Antiplatelet Therapy For Medically Managed Patients With Non-St-Segment Elevation Acute Coronary Syndromes
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- Cornel, Jan H. (author)
- Northwest Hospital Group, Alkmaar
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- Ohman, E. Magnus (author)
- Duke University
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- Neely, Benjamin (author)
- Duke University
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- Jakubowski, Joseph A. (author)
- Eli Lilly and Company
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- Bhatt, Deepak L. (author)
- Brigham and Women's Hospital / Harvard Medical School
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- White, Harvey D. (author)
- Auckland City Hospital
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- Ardissino, Diego (author)
- Parma University Hospital
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- Fox, Keith A.A. (author)
- University of Edinburgh
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- Prabhakaran, Dorairaj (author)
- Public Health Foundation of India
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- Armstrong, Paul W. (author)
- University of Alberta
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- Erlinge, David (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine
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Tantry, Udaya S. (author)
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Gurbel, Paul A. (author)
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- Roe, Matthew T. (author)
- Duke University
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(creator_code:org_t)
- 2016
- 2016
- English.
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In: Journal of the American Heart Association. - 2047-9980. ; 5:11
- Related links:
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http://dx.doi.org/10... (free)
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
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- Background--The relationship between "on-treatment" low platelet reactivity and longitudinal risks of major bleeding dual antiplatelet therapy following acute coronary syndromes remains uncertain, especially for patients who do not undergo percutaneous coronary intervention. Methods and Results--We analyzed 2428medicallymanaged acute coronary syndromes patients fromthe Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial who had serial platelet reactivity measurements (P2Y12 reaction units; PRUs) and were randomized to aspirin+prasugrel versus aspirin+clopidogrel for up to 30 months. Contal's method was used to determine whether a cut point for steady-state PRU values could distinguish high versus low bleeding risk using 2-level composites: Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) severe/life-threatening or moderate bleeding unrelated to coronary artery bypass grafting (CABG) and non-CABG Thrombolysis In Myocardial Infarction (TIMI) major orminor bleeding. Exploratory analyses used 3-level composites that incorporatedmild andminimalGUSTOand TIMI events.Continuousmeasures of PRUs (per 10-unit decrease)were not independently associatedwith the 2-levelGUSTO (adjusted hazard ratio [HR], 1.01; 95% CI, 0.96-1.06) or TIMI composites (1.02; 0.98-1.07). Furthermore, no PRU cut point could significantly distinguish bleeding risk using the 2-level composites.However, the PRUcut point of 75 differentiated bleeding riskwith the 3-level composites ofGUSTO(26.5% vs 12.6%; adjusted HR, 2.28; 95% CI, 1.77-2.94; P<0.001) and TIMI bleeding events (25.9% vs 12.2%; adjusted HR, 2.30; 95% CI, 1.78-2.97; P<0.001). Conclusions--Among medically managed non-ST-segment elevation acute coronary syndromes patients receiving prolonged dual antiplatelet therapy, PRU values were not significantly associated with the long-term risk of major bleeding events, suggesting that low on-treatment platelet reactivity does not independently predict serious bleeding risk.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- DAPT
- Hemorrhage
- Platelet
Publication and Content Type
- art (subject category)
- ref (subject category)
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- By the author/editor
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Cornel, Jan H.
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Ohman, E. Magnus
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Neely, Benjamin
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Jakubowski, Jose ...
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Bhatt, Deepak L.
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White, Harvey D.
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show more...
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Ardissino, Diego
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Fox, Keith A.A.
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Prabhakaran, Dor ...
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Armstrong, Paul ...
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Erlinge, David
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Tantry, Udaya S.
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Gurbel, Paul A.
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Roe, Matthew T.
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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Journal of the A ...
- By the university
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Lund University