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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EAn analysis of mortality in the DAPT study revealed that although there was a borderline increase in mortality in the continued thienopyridine arm, it was mainly related to non-cardiovascular deaths, and bleeding accounted for a minority of these deaths. Although cancer-related deaths were increased with continued thienopyridine, there was no difference in cancer incidence between randomized groups, and these deaths may have been attributed to an imbalance in subjects with known cancer at the time of enrollment, Although dual antiplatelet therapy beyond 12 months after coronary stenting should be considered for prevention of myocardial infarction, the risks should be considered carefully.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebleeding risk\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDAPT Study\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edual antiplatelet therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiovascular mortality\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecancer-related death\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethienopyridine\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EProlonged dual antiplatelet therapy beyond 1 year was associated with increased mortality in the DAPT study, but whether this was related to the increased bleeding rates seen in the study was unknown [Mauri L et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014]. A new analysis has revealed that cancer-related death accounted for the majority of the difference in mortality, and this appeared to be related to an imbalance in advanced cancers enrolled as there was no difference in cancer incidence, according to Laura Mauri, MD, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe DAPT Study found that dual antiplatelet therapy with a thienopyridine plus aspirin beyond 1 year after coronary stenting, vs aspirin alone, reduced ischemic complications, but increased moderate or severe bleeding in patients treated with drug-eluting stents. The rates of major adverse cardiovascular and cerebrovascular events (MACCE; a composite of death, myocardial infarction [MI], and stroke) and MI were significantly lower in the continued thienopyridine group (n\u2005=\u20055020) compared with the placebo group (n\u2005=\u20054941), at 4.3% vs 5.9%, and 2.1% vs 4.1%, respectively (both \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001); but the rate of all-cause death was higher in the continued thienopyridine group (2.0% vs 1.5%; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.05).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe objective of the present analysis was to adjudicate and analyze deaths following randomization for all subjects (treated with either drug-eluting or bare metal stents), with particular focus on bleeding- and cancer-related outcomes. A total of 11\u2005648 patients were randomized (5862 to continued thienopyridine vs 5786 to placebo).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThere was a trend toward increased all-cause mortality for the 12- to 30-month period at 1.9% in the continued thienopyridine group vs 1.5% in the placebo group (HR, 1.31; 95% CI, 0.97 to 1.75; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.07). It reached statistical significance for the 12- to 33-month period at 2.2% vs 1.8% (HR, 1.32; 95% CI, 1.00 to 1.73; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.05). In the continued thienopyridine group, non-cardiovascular (CV) death was more frequent during the 12- to 30-month period (0.9% vs 0.5%; HR, 1.94; 95% CI, 1.20 to 3.15; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.01), whereas CV death was numerically more frequent during the 30- to 33-month period, as thienopyridine treatment was discontinued (0.3% vs 0.1%; HR, 2.39; 95% CI, 0.84 to 6.77; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.09).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EFor the entire 12- to 33-month period, non-CV deaths and cancer-related deaths were significantly higher in the continued thienopyridine group compared with the placebo group, and the rate of bleeding-related deaths was very low and did not differ significantly between the groups (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). However, there was no difference in new cancer incidence after randomization. Most of these cancer-related deaths were solid tumors typical of such a population, rather than a particular location or cell type, and cancer deaths were rarely related to bleeding. Although life expectancy of less than 3 years was an exclusion criterion of the study, patients with cancer were allowed to be enrolled. These findings suggest that caution is warranted in choosing whether to continue long-term dual antiplatelet therapy in subjects with advanced cancer. There have been no observed increases in mortality [Elmariah S et al. \u003Cem\u003ELancet\u003C\/em\u003E. 2015] or cancer-related death [Hicks BM et al. \u003Cem\u003EPharmacoepidemiol Drug Saf\u003C\/em\u003E. 2015; Unger EF. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2009; Roe MT et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2012] across prior large randomized trials of thienopyridine therapy with extended follow-up.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/19\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mortality by Cause12-33 months; n\u0026#x2005;=\u0026#x2005;11\u0026#x2005;648 randomized.Reproduced with permission from L Mauri, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-996277978\u0022 data-figure-caption=\u0022Mortality by Cause12-33 months; n\u0026#x2005;=\u0026#x2005;11\u0026#x2005;648 randomized.Reproduced with permission from L Mauri, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/19\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/19\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/28\/19\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16967\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EMortality by Cause\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003E12-33 months; n\u2005=\u200511\u2005648 randomized.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EReproduced with permission from L Mauri, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EDr Mauri cautioned that there were several limitations to the study, including low event rates and the retrospective adjudication of cancer diagnosis. She concluded that dual antiplatelet therapy beyond 12 months after coronary stenting should be considered for the prevention of MI, but risks of continued dual antiplatelet therapy should be considered carefully.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/28\/19.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzl4sp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl4sp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}