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Temporal variations in ischemic and bleeding event risks after acute coronary syndrome during dual antiplatelet
Toshiharu Fujii1, Satoshi Kasai2, Yota Kawamura2
1Division of Cardiology, Tokai University School of Medicine, Isehara, Japan; Division of Cardiology, Tokai University Hachioji Hospital, Hachioji, Japan.
Insights
A 60-day dual antiplatelet therapy (DAPT) duration balances ischemic and bleeding risks after acute coronary syndrome (ACS). This duration is effective regardless of a patient's high bleeding risk (HBR) status.
Area of Science:
- Cardiology
- Clinical Research
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is crucial after acute coronary syndrome (ACS).
- Patient stratification using Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria is essential.
- Understanding temporal risk variations in ischemic and bleeding events during DAPT is critical.
Purpose of the Study:
- To estimate temporal risk variations of ischemic and bleeding events during DAPT.
- To stratify patients based on ARC-HBR criteria.
- To determine the optimal DAPT duration after ACS.
Main Methods:
- 1264 ACS patients receiving aspirin plus clopidogrel or prasugrel were classified by ARC-HBR.
- Multicenter observational study design.
- Cox hazard and Royston-Parmar models used to estimate temporal risk variations.
Main Results:
- Ischemic events occurred in 9.4% and bleeding events in 7.4% over 313 days.
- High bleeding risk (HBR) patients had significantly higher rates of both ischemic (15.3%) and bleeding (11.9%) events.
- Ischemic event risk surpassed bleeding event risk within 60 days for both HBR and non-HBR groups.
Conclusions:
- A 60-day DAPT duration effectively balances ischemic and bleeding event risks post-ACS.
- This DAPT duration is appropriate irrespective of the patient's ARC-HBR classification.
- The findings support a standardized 60-day DAPT regimen for ACS patients.
Background:
This study estimates the temporal risk variations of ischemic and bleeding events during dual antiplatelet therapy (DAPT) among patients stratified according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria, suggesting the optimal period for DAPT after acute coronary syndrome (ACS).
Methods:
A total of 1264 ACS patients receiving either clopidogrel or prasugrel with aspirin were classified by ARC-HBR; HBR (n = 574) and non-HBR groups (n = 690). This study was designed as a multicenter observation to evaluate the primary endpoints of ischemic, including cardiovascular death, myocardial infarction, or ischemic stroke, and bleeding events, defined as Bleeding Academic Research Consortium type 3/5. The temporal risk variations were estimated using the Cox hazard and Royston-Parmar models.
Results:
Ischemic and bleeding events were observed in 9.4% and 7.4%, respectively, during an average observation period of 313 days. The HBR group had a higher incidence of both events than the non-HBR group (15.3% vs. 4.5%, P < 0.01 for ischemic; 11.9% vs. 3.8%, P < 0.01 for bleeding). The estimated risk curves for both events revealed peaks and steep declines in the first few days, followed by constant declines. The peak of risk was higher for bleeding than for ischemic events, but this relationship reversed early, with ischemic events displaying a higher risk in both the HBR and non-HBR groups until at least 60 days.
Conclusions:
A 60-day period of DAPT is appropriate to balance the risks of adverse events after ACS, regardless of ARC-HBR criteria.
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