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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.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\u003EIn the Triple Therapy in Patients on Oral Anticoagulation After Drug Eluting Stent Implantation trial [ISAR-TRIPLE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00776633\u0026amp;atom=%2Fspmdc%2F14%2F30%2F8.atom\u0022\u003ENCT00776633\u003C\/a\u003E], 6 weeks of triple therapy including the oral antiplatelet compound clopidogrel is not superior to a 6-month regimen following implantation of a drug-eluting stent.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn the Triple Therapy in Patients on Oral Anticoagulation After Drug Eluting Stent Implantation trial [ISAR-TRIPLE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00776633\u0026amp;atom=%2Fspmdc%2F14%2F30%2F8.atom\u0022\u003ENCT00776633\u003C\/a\u003E], 6 weeks of triple therapy including the oral antiplatelet compound clopidogrel is not superior to a 6-month regimen following implantation of a drug-eluting stent (DES). The results were reported by Nikolaus Sarafoff, MD, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPrevious studies support the view that combined oral anticoagulant\/antiplatelet therapy is advantageous in reducing adverse outcomes following cardiac surgeries [Connolly S et al. \u003Cem\u003ELancet\u003C\/em\u003E. 2006]. However, triple therapy comes with the drawback of increased risk of bleeding. The optimal length of therapy to maximize the benefits while minimizing bleeding risk following DES implantation is unknown.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe risk of stent thrombosis is greatest soon after percutaneous coronary intervention and declines thereafter. Also, bleeding risk depends on the length and intensity of oral anticoagulant therapy [Lip GYH et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2014]. Informed by this knowledge, the ISAR-TRIPLE prospective, randomized, open-label trial evaluated clinical outcomes of a 6-week and 6-month regimen of clopidogrel along with aspirin and oral anticoagulation following DES implantation in 614 patients [Fiedler KA et al. \u003Cem\u003EAm Heart J.\u003C\/em\u003E 2014]. The hypothesis was that the shorter course of therapy is superior.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EDES implantation and need for oral anticoagulation were the inclusion criteria. Exclusion criteria included prior stent thrombosis and DES implantation in the left main coronary artery. The primary end point was death, myocardial infarction (MI), confirmed stent thrombosis, stroke, or major bleeding at 9 months. Secondary end points included ischemic complications (cardiac death, MI, stent thrombosis, ischemic stroke) and major bleeding.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAll patients received aspirin (75\u2013200 mg QD) and vitamin K antagonist along with clopidogrel 75 mg QD for 6 weeks (n = 307) or 6 months (n = 307). Phenprocoumon or warfarin were used in patients with mechanical valves (5% and 9% of the 6-week and 6-month group, respectively) to achieve a target internal normalized ratio. Clinical follow-up was done after 9 months for most patients (n = 606 [98.7%]; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\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\/14\/30\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022ISAR-TRIPLE Design\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2013067889\u0022 data-figure-caption=\u0022ISAR-TRIPLE Design\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\/14\/30\/8\/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\/14\/30\/8\/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\/14\/30\/8\/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\/11908\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 attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EISAR-TRIPLE Design\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EASA, aspirin; PCI, percutaneous coronary intervention.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EA: 6-week group; B: 6-month group.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-3\u0022\u003EReproduced from \u003Cem\u003EAmerican Heart Journal\u003C\/em\u003E, 167, Fiedler KA et al, Rationale and design of The Intracoronary Stenting and Antithrombotic Regimen\u2014Testing of a six-week versus a six-month clopidogrel treatment Regimen In Patients with concomitant aspirin and oraL anticoagulant therapy following drug-Eluting stenting (ISAR-TRIPLE) study, 459\u2013465, Copyright 2014, with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EAt baseline, the 2 groups were similar in age; sex; history of MI; prevalence of diabetes, acute coronary syndrome, and stable angina; and indication of oral anticoagulants. Compliance with all medications was excellent, with the exceptions of clopidogrel use by those in the 6-week group after 6 weeks (26% vs 87% in the 6-month group; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) and at the 9-month follow-up (23% vs 35%; \u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThere were no significant differences between the 2 groups in either the primary end point (HR, 1.14; 95% CI, 0.68 to 1.91; \u003Cem\u003EP\u003C\/em\u003E = .63) or the secondary end points of ischemic complications (HR, 0.93; 95% CI, 0.43 to 2.05; \u003Cem\u003EP\u003C\/em\u003E = .87) and major bleeding (HR, 1.35; 95% CI, 0.64 to 2.84; \u003Cem\u003EP\u003C\/em\u003E = .44).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EParsing out the secondary end point data did reveal a significant difference in MI (6-week, n = 6 [2.0%]; 6-month, n = 0; \u003Cem\u003EP\u003C\/em\u003E = .029). Bleeding Academic Research Consortium (BARC)-defined bleeding overall did not differ significantly between the groups (6-week, 37.6%; 6-month, 40.2%; HR, 0.94; 95% CI, 0.73 to 1.21; \u003Cem\u003EP\u003C\/em\u003E = .63). But, comparison of BARC-defined bleeding prior to randomization with that occurring at 9 months was significant (6-week, 20.5%; 6-month, 27.9%; HR, 0.68; 95% CI, 0.47 to 0.98; \u003Cem\u003EP\u003C\/em\u003E = .04).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EProf Sarafoff concluded that shortening clopidogrel therapy from 6 months to 6 weeks after DES implantation in patients who are also receiving aspirin and oral anticoagulation is not superior in terms of net clinical outcomes.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\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\/14\/30\/8.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?nzosz1\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?nzosz1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}