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Evaluation of Dual ...
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Peterson, Benjamin E.Harvard Med Sch, Heart & Vasc Ctr, Brigham & Womens Hosp, Boston, MA 02115 USA.
(author)
Evaluation of Dual Versus Triple Therapy by Landmark Analysis in the RE-DUAL PCI Trial
- Article/chapterEnglish2021
Publisher, publication year, extent ...
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American College of Cardiology,2021
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LIBRIS-ID:oai:DiVA.org:uu-442512
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-442512URI
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https://doi.org/10.1016/j.jcin.2021.02.022DOI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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OBJECTIVES: The aim of this study was to explore the early versus late benefits and risks of dabigatran dual therapy versus warfarin triple therapy in the RE-DUAL PCI (Randomized Evaluation of Dual Antithrombotic Therapy With Dabi-gatran Versus Triple Therapy With Warfarin in Patients With Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) trial.BACKGROUND: Patients with atrial fibrillation who undergo percutaneous coronary intervention are at increased risk for both bleeding and thrombotic events.METHODS: A total of 2,725 patients with atrial fibrillation underwent percutaneous coronary intervention and were randomized to receive dabigatran 110 mg, or dabigatran 150 mg plus a P2Y(12) inhibitor (and no aspirin), or warfarin plus a P2Y(12) inhibitor plus aspirin. Landmark analysis was performed at 30 and 90 days.RESULTS: There was a consistent and large reduction in major or clinically relevant nonmajor bleeding in patients randomized to dual therapy during the first 30 days (110 mg: hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.31 to 0.66; p < 0.0001; 150 mg: HR: 0.46; 95% CI: 0.30 to 0.72; p = 0.0006) compared with warfarin triple therapy. There was early net clinical benefit in both dabigatran groups versus warfarin (110 mg: HR: 0.65; 95% CI: 0.47 to 0.88; p = 0.0062; 150 mg: HR: 0.54; 95% CI: 0.37 to 0.79; p = 0.0015), due to larger reductions in bleeding than increased thrombotic events for dabigatran 110 mg and bleeding reduction without increased thrombotic risk for dabigatran 150 mg dual therapy versus warfarin triple therapy. After the removal of aspirin in the warfarin group, bleeding remained lower with dabigatran 110 mg and was similar with dabigatran 150 mg versus warfarin.CONCLUSIONS: In RE-DUAL PCI, in which patients in the dual-therapy arms were treated with aspirin for an average of only 1.6 days, there was early net clinical benefit with both doses of dabigatran dual therapy, without an increase in thrombotic events with dabigatran 150 mg. This could be helpful in the subset of patients with elevated risk for both bleeding and thrombotic events.
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Bhatt, Deepak L.Harvard Med Sch, Heart & Vasc Ctr, Brigham & Womens Hosp, Boston, MA 02115 USA.
(author)
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Steg, Ph GabrielUniv Paris, Hop Bichat, AP HP, FACT French Alliance Cardiovasc Trials, Paris, France.;INSERMU1148, Paris, France.
(author)
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Oldgren, Jonas,1964-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)jonaoldg
(author)
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Maeng, MichaelAarhus Univ Hosp, Aarhus, Denmark.
(author)
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Zeymer, UweKlinikum Stadt Ludwigshafen, Ludwigshafen, Germany.
(author)
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Halvorsen, SigrunOslo Univ Hosp Ulleval, Dept Cardiol, Oslo, Norway.;Univ Oslo, Oslo, Norway.
(author)
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Hohnloser, Stefan H.Goethe Univ Frankfurt, Dept Med, Div Cardiol, Frankfurt, Germany.
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Lip, Gregory Y. H.Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England.;Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England.;Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark.
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Kimura, TakeshiKyoto Univ, Dept Cardiovasc Med, Kyoto, Japan.
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Nordaby, MatiasBoehringer Ingelheim GmbH & Co KG, Ingelheim, Germany.
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Miede, CorinnaMainanalytics, Sulzbach, Germany.
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Kleine, EvaBoehringer Ingelheim GmbH & Co KG, Ingelheim, Germany.
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Ten Berg, Jurrien M.St Antonius Hosp, Nieuwegein, Netherlands.;Med Univ Ctr Maastricht, Maastricht, Netherlands.
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Cannon, Christopher P.Harvard Med Sch, Heart & Vasc Ctr, Brigham & Womens Hosp, Boston, MA 02115 USA.
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Harvard Med Sch, Heart & Vasc Ctr, Brigham & Womens Hosp, Boston, MA 02115 USA.Univ Paris, Hop Bichat, AP HP, FACT French Alliance Cardiovasc Trials, Paris, France.;INSERMU1148, Paris, France.
(creator_code:org_t)
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In:JACC: American College of Cardiology14:7, s. 768-7801936-87981876-7605
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