Outcomes of Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Receiving an Oral Anticoagulant and Dual Antiplatelet Therapy: A Comparison of Clopidogrel Versus Prasugrel From the TRANSLATE-ACS Study

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• 作者：Larry R. Jackson II ; MD^&lowast ; ; ^{larry.jackson@dm.duke.edu" class="auth_mail" title="E-mail the corresponding author} ; Christine Ju ; MS^&lowast ; ; Marjorie Zettler ; PhD ; MPH^&dagger ; ; John C. Messenger ; MD^&Dagger ; ; David J. Cohen ; MD^§ ; ; Gregg W. Stone ; MD^‖ ; Brian A. Baker ; PharmD^¶ ; ; Mark Effron ; MD^&dagger ; ; Eric D. Peterson ; MD ; MPH^&lowast ; ; Tracy Y. Wang ; MD ; MHS ; MSc^&lowast ;
• 关键词：bleeding risk ; P2Y12 receptor inhibitor agents ; triple therapy
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2015
• 出版时间：21 December 2015
• 年：2015
• 卷：8
• 期：14
• 页码：1880-1889
• 全文大小：628 K

文摘

The purpose of this study was to determine whether bleeding risk varies depending on which P2Yb>12b> receptor inhibitor agent is used.

bsSec_2">Background

bspara0015">Prior studies have shown significant bleeding risk among patients treated with triple therapy (i.e., oral anticoagulant, P2Yb>12b> receptor inhibitor, and aspirin).

bsSec_3">Methods

bspara0020">We evaluated patients with acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) at 233 hospitals in the United States enrolled in the TRANSLATE-ACS (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study (April 2010 to October 2012). Using inverse probability-weighted propensity modeling, we compared 6-month adjusted risks of Bleeding Academic Research Consortium (BARC) bleeding, stratifying by whether or not bleeding was associated with rehospitalization among patients discharged on aspirin + anticoagulant + clopidogrel (triple-C), aspirin + anticoagulant + prasugrel (triple-P), aspirin + clopidogrel (dual-C), or aspirin + prasugrel (dual-P).

bsSec_4">Results

bspara0025">Of 11,756 MI patients, 526 (4.5%) were discharged on triple-C, 91 (0.8%) on triple-P, 7,715 (66%) on dual-C, and 3,424 (29%) on dual-P. Compared with dual-therapy patients, triple-therapy patients had significantly higher any BARC-defined bleeding. Triple-P was associated with a greater risk of any BARC-defined bleeding events compared with triple-C. This finding was driven mostly by an increased risk of bleeding events that were patient-reported only and did not require rehospitalization. There were no significant differences in bleeding requiring rehospitalization between the triple-P and -C groups.

bsSec_5">Conclusions

bspara0030">Among MI patients, the addition of an oral anticoagulant was associated with a significantly greater risk of any BARC-defined bleeding relative to dual antiplatelet therapy, regardless of which P2Yb>12b> receptor inhibitor was selected. Among patients on triple therapy, prasugrel use was associated with higher patient-reported–only bleeding, but not bleeding requiring rehospitalization, than clopidogrel-treated patients.