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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\n\u003Cp id=\u0022p-1\u0022\u003EPEGASUS-TIMI 54 and DAPT trials demonstrated that dual antiplatelet therapy reduced the risk of cardiovascular death, myocardial infarction, or stroke among patients with a history of myocardial infarction, and reduced the risk of ischemic events in patients receiving coronary stents when compared with treatment with aspirin alone but is associated with significantly increased risk of bleeding complications.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eantiplatelet therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDAPT\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EP2Y12 receptor antagonist\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPEGASUS-TIMI 54\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estent\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estroke\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eticagrelor\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ETIMI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ethienopyridine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT00526474\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT00977938\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003EThe use of dual antiplatelet therapy (DAPT) in which a P2Y12 receptor antagonist is combined with aspirin is recommended to reduce the risk of ischemic events or thrombosis in some at-risk patient populations. However, whether prolonged therapy may be beneficial for some patients has not been fully elucidated. Marc S. Sabatine, MD, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA, presented results of the PEGASUS-TIMI 54 trial [Bonaca MP et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2015], demonstrating that the addition of ticagrelor to low-dose aspirin reduced the risk of cardiovascular (CV) death, myocardial infarction (MI), or stroke, and increased the risk of TIMI major bleeding among patients with a history of MI. Robert W. Yeh, MD, Massachusetts General Hospital, Boston, Massachusetts, USA, presented results of a post hoc subgroup analysis [Yeh RW et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2015] of the DAPT Study showing that continuation of a thienopyridine plus aspirin vs aspirin alone beyond 1 year reduced the risk of ischemic events in patients with and without acute coronary syndromes (ACSs) receiving coronary stents.\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003EPEGASUS-TIMI 54 was a multicenter, international, randomized, double-blind, placebo-controlled clinical trial that investigated whether long-term therapy with ticagrelor would reduce the risk of major adverse CV events in stable patients with a history of MI receiving low-dose aspirin. The primary efficacy end point was the composite of CV death, MI, or stroke. Secondary end points were CV death and all-cause death. The primary safety end point was TIMI major bleeding. Other safety end points included intracranial hemorrhage and fatal bleeding.\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EA total of 21,162 patients were randomized: 7050 received ticagrelor 90 mg BID, 7045 received ticagrelor 60 mg BID, and 7067 received placebo. The median follow-up was 33 months.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EAt 36 months, ticagrelor significantly reduced the rate of the primary composite end point at both doses, with 9.0% of patients in the placebo group experiencing an event vs 7.8% in both groups receiving ticagrelor (90 mg BID: HR, 0.85; 95% CI, 0.75 to 0.96; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.008, and 60 mg BID: HR, 0.84; 95% CI, 0.74 to 0.95; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.004). Dr Sabatine noted that the event curves for both ticagrelor groups separated early (within 2 to 3 months) from the placebo event curve and continued to diverge over time. Treatment with ticagrelor was also consistently favored when individual components of the primary end point were analyzed separately and in prespecified patient subgroups.\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EThe rate of TIMI major bleeding was significantly higher with the 2 ticagrelor doses as compared with placebo; 2.6% in patients receiving ticagrelor 90 mg (HR, 2.69; 95% CI, 1.96 to 3.70; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001), 2.3% in those receiving ticagrelor 60 mg (HR, 2.32; 95% CI, 1.68 to 3.21; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001), and 1.1% in those on placebo. However, the rates of fatal bleeding or nonfatal intracranial hemorrhage did not differ significantly between either ticagrelor group and placebo (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.47). Dyspnea occurred significantly more frequently with ticagrelor 90 mg and 60 mg than with placebo (18.9%, 15.8%, and 6.4%, respectively; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001). Gout also was significantly more frequent with ticagrelor 90 mg (2.3%; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001) and 60 mg (2.0%; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.01) than with placebo (1.5%).\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003EDr Sabatine concluded that the addition of ticagrelor to low-dose aspirin in stable patients with a history of MI reduced the risk of CV death, MI, or stroke and that long-term DAPT with low-dose aspirin and ticagrelor should be considered in appropriate patients with MI.\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003EThe DAPT Study was a multicenter, international, prospective, randomized, double-blind, clinical trial that showed 30 months vs 12 months of DAPT in patients who had coronary stenting was more effective in reducing the primary end points of stent thrombosis and the composite of death, MI, or stroke, but it was associated with a significantly increased risk of moderate or severe bleeding [Mauri L et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E. 2014].\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EIn this post hoc subgroup analysis of the 11,648 patients randomized at 12 months in the DAPT Study, 3576 patients had an ACS (1805 continued thienopyridine, 1771 received placebo) and 8072 patients did not have an ACS (4057 continued thienopyridine, 4015 received placebo) [Yeh RW et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2015]. The patients with ACS were younger and had fewer comorbidities than the patients without ACS. In both groups, approximately one-third of patients randomized to a thienopyridine received prasugrel and two-thirds received clopidogrel.\u003C\/p\u003E\n\u003Cp id=\u0022p-10\u0022\u003EContinued thienopyridine therapy significantly and consistently reduced the rate of stent thrombosis in both patients with ACS (0.5% vs 1.9% on thienopyridine vs placebo, respectively; HR, 0.27; 95% CI, 0.13 to 0.57; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001) and without ACS (0.4% vs 1.1% on thienopyridine vs placebo, respectively; HR, 0.33; 95% CI, 0.18 to 0.60; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). The rate of the composite of death, MI, and stroke was reduced significantly among patients with ACS (3.9%; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001 vs placebo), but no significant difference was found among patients without ACS (4.5%; \u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.09 vs placebo). Moderate and severe bleeding was consistently increased by thienopyridine therapy among both patients with ACS (1.9% vs 0.8% with placebo; HR, 2.38; 95% CI, 1.27 to 4.43; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.005) and patients without ACS (2.6% vs 1.7% with placebo; HR, 1.53; 95% CI, 1.12 to 2.08; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.007).\u003C\/p\u003E\n\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\/5\/7\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Primary End Points of the DAPT Study at 12 to 30 MonthsACS, acute coronary syndrome; MACCE, major adverse cardiac and cerebrovascular event.Reproduced with permission from RW Yeh, MD.Source: Yeh RW et al. J Am Coll Cardiol. 2015.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-376980119\u0022 data-figure-caption=\u0022\u0026amp;lt;div xmlns=\u0026amp;quot;http:\/\/www.w3.org\/1999\/xhtml\u0026amp;quot;\u0026amp;gt;Primary End Points of the DAPT Study at 12 to 30 MonthsACS, acute coronary syndrome; MACCE, major adverse cardiac and cerebrovascular event.Reproduced with permission from RW Yeh, MD.Source: Yeh RW et al. \u0026amp;lt;em\u0026amp;gt;J Am Coll Cardiol.\u0026amp;lt;\/em\u0026amp;gt; 2015.\u0026amp;lt;\/div\u0026amp;gt;\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\/5\/7\/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\/5\/7\/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\/5\/7\/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\/16212\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-11\u0022 class=\u0022first-child\u0022\u003EPrimary End Points of the DAPT Study at 12 to 30 Months\u003C\/p\u003E\n\u003Cp id=\u0022p-12\u0022\u003EACS, acute coronary syndrome; MACCE, major adverse cardiac and cerebrovascular event.\u003C\/p\u003E\n\u003Cp id=\u0022p-13\u0022\u003EReproduced with permission from RW Yeh, MD.\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003ESource: Yeh RW et al. \u003Cem\u003EJ Am Coll Cardiol.\u003C\/em\u003E 2015.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-15\u0022\u003EDr Yeh concluded that DAPT with a thienopyridine plus aspirin beyond 1 year reduced the risk of stent thrombosis for all patients and major adverse cardiac and cerebrovascular events among patients with ACS compared with treatment with aspirin alone, and continuation of DAPT for 30 months should be strongly considered in the appropriate patient.\u003C\/p\u003E\n\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\/5\/7.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?nzloxp\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?nzloxp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}