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Comparison of the Effect of Age (< 75 Versus ≥ 75) on the Efficacy and Safety of Dual Therapy (Dabigatran + Clopidogrel or Ticagrelor) Versus Triple Therapy (Warfarin + Aspirin + Clopidogrel or Ticagrelor) in Patients With Atrial Fibrillation After Percutaneous Coronary Intervention (from the RE-DUAL PCI Trial).
- Source :
-
The American journal of cardiology [Am J Cardiol] 2020 Mar 01; Vol. 125 (5), pp. 735-743. Date of Electronic Publication: 2019 Dec 09. - Publication Year :
- 2020
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Abstract
- The RE-DUAL PCI trial reported that dabigatran dual therapy (110/150 mg twice daily, plus clopidogrel or ticagrelor) reduced bleeding events versus warfarin triple therapy (warfarin plus aspirin and clopidogrel or ticagrelor) in patients with atrial fibrillation who underwent percutaneous coronary intervention, with noninferiority in composite thromboembolic events. In this prespecified analysis, risks of first major or clinically relevant nonmajor bleeding event and composite end point of death, thromboembolic events, or unplanned revascularization were compared between dabigatran dual therapy and warfarin triple therapy in older (≥ 75 years) and younger (< 75 years) patients, using Cox proportional hazard regression. Of 2,725 patients randomized to treatment, 1,026 (37.7%) were categorized into older and 1,699 (62.3%) into younger age groups. Dabigatran 110 mg dual therapy lowered bleeding risk versus warfarin triple therapy in older (hazard ratio [HR] 0.67; 95% confidence interval [CI] 0.51 to 0.89) and younger patients (HR 0.40; 95% CI 0.30 to 0.54); interaction p value: 0.0125. Dabigatran 150 mg dual therapy lowered bleeding risk versus warfarin triple therapy in younger patients (HR 0.57; 95% CI 0.44 to 0.74), whereas no benefit could be observed in older patients (HR 1.21; 95% CI 0.83 to 1.77); interaction p value: 0.0013. For the thromboembolic end point, there was a trend for a higher risk with dabigatran 110 mg dual therapy in older patients, compared with warfarin triple therapy, whereas the risk was similar in younger patients. For dabigatran 150 mg dual therapy, the thromboembolic risk versus warfarin triple therapy was similar in older and younger patients. In conclusion, the benefits of dabigatran dual therapy differed in the 2 age groups, which may help dose selection when using dabigatran dual therapy.<br /> (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Aspirin therapeutic use
Atrial Fibrillation complications
Clopidogrel therapeutic use
Drug Therapy, Combination
Female
Hemorrhage chemically induced
Humans
Male
Middle Aged
Myocardial Revascularization statistics & numerical data
Proportional Hazards Models
Stroke etiology
Thromboembolism epidemiology
Ticagrelor therapeutic use
Treatment Outcome
Anticoagulants therapeutic use
Atrial Fibrillation drug therapy
Coronary Artery Disease therapy
Dabigatran therapeutic use
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors therapeutic use
Stroke prevention & control
Warfarin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 125
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 31924322
- Full Text :
- https://doi.org/10.1016/j.amjcard.2019.11.029