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Real-world bleeding in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and prescribed different combinations of dual antiplatelet therapy (DAPT) in England : a population-based cohort study emulating a ‘target trial’
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Pufulete, Maria, Harris, Jessica, Pouwels, Koen, Reeves, Barney C., Lasserson, Daniel, Loke, Yoon K., Mumford, Andrew, Mahadevan, Kalaivani and Johnson, Thomas W. (2022) Real-world bleeding in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and prescribed different combinations of dual antiplatelet therapy (DAPT) in England : a population-based cohort study emulating a ‘target trial’. Open Heart, 9 (2). e001999. doi:10.1136/openhrt-2022-001999 ISSN 2053-3624.
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Official URL: https://doi.org/10.1136/openhrt-2022-001999
Abstract
Objective: To estimate the incidence and HRs for bleeding for different dual antiplatelet therapies (DAPT) in a real-world population with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in England. Design: A retrospective, population-based cohort study emulating a target randomised controlled trial (tRCT). Data sources: Linked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES). Setting: Primary and secondary care. Participants: Patients ≥18 years old with ACS undergoing emergency PCI. Interventions: Aspirin and clopidogrel (AC, reference) versus aspirin and prasugrel (AP) or aspirin and ticagrelor (AT); AP evaluated only in patients with ST-elevation myocardial infarction (STEMI). Main outcome measures: Primary: any bleeding up to 12 months after the index event (HES- or CPRD- recorded). Secondary: HES-recorded bleeding, CPRD-recorded bleeding, all-cause and cardiovascular mortality, mortality from bleeding, myocardial infarction, stroke, additional coronary intervention and major adverse cardiovascular and cerebrovascular events (MACCE). Results: In ACS, the rates of any bleeding for AC and AT were 89 per 1000 person years and 134 per 1000 person years, respectively. In STEMI, rates for AC, AP and AT were 93 per 1000 person years, 138 per 1000 person years and 143 per 100 person years, respectively. In ACS, compared with AC, AT increased the hazard of any bleeding (HR: 1.47, 95% CI 1.19 to 1.82) but did not reduce MACCE (HR: 1.06, 95% CI 0.89 to 1.27). In STEMI, compared with AC, AP and AT increased the hazard of any bleeding (HR: 1.77, 95% CI 1.21 to 2.59 and HR: 1.50, 95% CI 1.10 to 2.05, respectively) but did not reduce MACCE (HR: 1.10, 95% CI 0.80 to 1.51 and HR: 1.21, 95% CI 0.94 to 1.51, respectively). Non-adherence to the prescribed DAPT regimen was 28% in AC (29% in STEMI only), 31% in AP (STEMI only) and 33% in AT (32% in STEMI only). Conclusions: In a real-world population with ACS, DAPT with ticagrelor or prasugrel are associated with increased bleeding compared with DAPT with clopidogrel. Trial registration number: ISRCTN76607611.
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | |||||||||
Library of Congress Subject Headings (LCSH): | Coronary heart disease -- Treatment, Coronary heart disease -- Surgery , Cardiac catheterization -- Complications , Heart -- Hemorrhage -- Prevention, Blood platelets | |||||||||
Journal or Publication Title: | Open Heart | |||||||||
Publisher: | B M J Group | |||||||||
ISSN: | 2053-3624 | |||||||||
Official Date: | 12 August 2022 | |||||||||
Dates: |
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Volume: | 9 | |||||||||
Number: | 2 | |||||||||
Article Number: | e001999 | |||||||||
DOI: | 10.1136/openhrt-2022-001999 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 31 August 2022 | |||||||||
Date of first compliant Open Access: | 1 September 2022 | |||||||||
RIOXX Funder/Project Grant: |
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