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Search: (WFRF:(Valgimigli M)) > (2020-2023) > Antithrombotic ther...

  • Costa, Francesco (author)

Antithrombotic therapy according to baseline bleeding risk in patients with atrial fibrillation undergoing percutaneous coronary intervention : applying the PRECISE-DAPT score in RE-DUAL PCI.

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • 2020-12-01
  • Oxford University Press (OUP),2020
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-430341
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-430341URI
  • https://doi.org/10.1093/ehjcvp/pvaa135DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • AIMS: Patients with atrial fibrillation undergoing coronary intervention are at higher bleeding risk due to the concomitant need for oral anticoagulation and antiplatelet therapy. The RE-DUAL PCI trial demonstrated better safety with dual antithrombotic therapy (DAT: dabigatran 110 or 150 mg bid, clopidogrel or ticagrelor) compared to triple antithrombotic therapy (TAT: warfarin, clopidogrel or ticagrelor, and aspirin). We explored the impact of baseline bleeding risk based on the PRECISE-DAPT score for decision-making regarding DAT vs. TAT.METHODS AND RESULTS: A score ≥25 points qualified high bleeding-risk (HBR). Comparisons were made for the primary safety endpoint ISTH major or clinically relevant non-major bleeding, and the composite efficacy endpoint of death, thromboembolic events, or unplanned revascularization, analyzed by time-to-event analysis. PRECISE-DAPT was available in 2,336/2,725 patients, and 37.9% were HBR. Compared to TAT, DAT with dabigatran 110 mg reduced bleeding risk both in non-HBR (HR 0.42, 95%CI, 0.31-0.57) and HBR (HR 0.70, 95%CI, 0.52-0.94), with a greater magnitude of benefit among non-HBR (Pint=0.02). DAT with dabigatran 150 mg vs. TAT reduced bleeding in non-HBR (HR 0.60, 95%CI, 0.45-0.80), with a trend toward less benefit in HBR patients (HR 0.92, 95%CI, 0.63-1.34, Pint=0.08). Risk of ischaemic events was similar on DAT with dabigatran (both 110 and 150 mg) vs. TAT in non-HBR and HBR patients (Pint=0.45 and Pint=0.56, respectively).CONCLUSIONS: PRECISE-DAPT score appeared useful to identify AF patients undergoing PCI at further increased risk of bleeding complications, and may help clinicians identifying the antithrombotic regimen intensity with the best benefit-risk ratio in an individual patient.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Valgimigli, Marco (author)
  • Steg, Philippe Gabriel (author)
  • Bhatt, Deepak L (author)
  • Hohnloser, Stefan H (author)
  • Ten Berg, Jurrien M (author)
  • Miede, Corinna (author)
  • Nordaby, Matias (author)
  • Lip, Gregory Y H (author)
  • Oldgren, Jonas,1964-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)jonaoldg (author)
  • Cannon, Christopher P (author)
  • Uppsala universitetUppsala kliniska forskningscentrum (UCR) (creator_code:org_t)

Related titles

  • In:European Heart Journal - Cardiovascular Pharmacotherapy: Oxford University Press (OUP)8:3, s. 216-2262055-68372055-6845

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