Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/336275
Type: Artigo
Title: Benefit and risks of aspirin in addition to ticagrelor in acute coronary syndromes: a post hoc analysis of the randomized global leaders trial
Author: Tomaniak, Mariusz
Chichareon, Ply
Onuma, Yoshinobu
Deliargyris, Efthymios N.
Takahashi, Kuniaki
Kogame, Norihiro
Modolo, Rodrigo
Chang, Chun Ching
Rademaker-Havinga, Tessa
Storey, Robert F.
Dangas, George D.
Hernndez Antolin, Rosa Ana
Goicolea, Javier
Ribeiro, Vasco Gama
da Silva, Pedro Canas
Ferreira, Rui Cruz
Almeida, Manuel
Ungi, Imre
Merkely, Bela
Fontos, Geza
Horvath, Ivan
Walsh, Simon
Koszegi, Zsolt
Jambrik, Zoltan
Edes, Istvan
Jozsef, Falukozy
Colombo, Antonio
Bolognese, Leonardo
Ferrario, Maurizio
Tumscitz, Carlo
Dominici, Marcello
Curello, Salvatore
Adlam, David
Roffi, Marco
Eeckhout, Eric
Moccetti, Tiziano
Moschovitis, Aris
Leibundgut, Gregor
Huber, Kurt
Frey, Bernhard
Delle Karth, Georg
Friedrich, Guy
Steinwender, Clemens
Cotton, James
Zweiker, Robert
Stables, Rod H.
Anderson, Richard
Chowdhary, Saqib
Garg, Scot
Hildick-Smith, David
Fath-Ordoubadi, Farzin
Oldroyd, Keith G.
Galasko, Gavin
Kukreja, Neville
Holmvang, Lene
Zaman, Azfar
Subkovas, Eduardas
Curzen, Nick
Hoole, Stephen
Talwar, Suneel
Ottesen, Michael Munndt
Buszman, Pawel
Zurakowski, Aleksander
Galuszka, Grzegorz
Prokopczuk, Janusz
Zmudka, Krzysztof
Bhatt, Deepak L.
Jasionowicz, Pawel
Mlodziankowski, Adam
Liebetrau, Christoph
Naber, Christoph Kurt
Neumann, Franz-Josef
Schchinger, Volker
Seidler, Tim
Ibrahim, Karim
Zrenner, Bernhard
Gori, Tommaso
Angiolillo, Dominick J.
Werner, Nikos
Akin, Ibrahim
Geisler, Tobias
vom Dahl, Juergen
Haude, Michael
Eitel, Ingo
Krackhardt, Florian
Jung, Werner
Lemos Neto, Pedro Alves
Sousa, Amanda
Hamm, Christian
Quintella, Edgard Freitas
Leandro, Sergio
Botelho, Roberto
Raffel, Christopher
Barlis, Peter
Hai, Koh Tian
Ong, Paul
Petrov, Ivo
Konteva, Mariana
Velchev, Vasil
Valgimigli, Marco
Gelev, Valeri
Tonev, Gincho
Valkov, Veselin
Vassilev, Dobrin
Trendafilova-Lazarova, Diana
Windecker, Stephan
Steg, Philippe Gabriel
Vranckx, Pascal
Serruys, Patrick W.
Bertrand, Olivier F.
Plante, Sylvain
Van Geuns, Robert-Jan
Hofma, Sjoerd H.
Royaards, Kees-Jan
Slagboom, Ton
Suryapranata, Harry
Umans, Victor A. W. M.
Rensing, Benno
van der Harst, Pim
Magro, Michael
Barbato, Emanuel
Aminian, Adel
Benit, Edouard
Janssens, Luc
Vrolix, Mathias
Buysschaert, Ian
Carrie, Didier
Barraud, Pascal
Teiger, Emmanuel
Koning, Ren
Farzin, Beygui
Morelle, Jean-francois
Isaaz, Karl
Maillard, Luc
Abdellaoui, Mohamed
Brunel, Philippe
Angioi, Michael
Lantelme, Pierre
Sabate, Manel
Albarran Gonzalez-Trevilla, Agustin
Cequier, Angel
Iiguez, Andres
Serra Penaranda, Antonio
Macaya Miguel, Carlos
Francisco Diaz, Jose
Abstract: What are the benefits and risks of continuing aspirin in addition to P2Y12 receptor inhibition with ticagrelor among patients with acute coronary syndrome between 1 month and 12 months after percutaneous coronary intervention? FindingsIn this nonprespecified, post hoc analysis of the GLOBAL LEADERS randomized clinical trial, beyond 1 month after percutaneous coronary intervention in acute coronary syndrome, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. MeaningThe findings of this hypothesis-generating analysis pave the way for further trials evaluating aspirin-free antiplatelet strategies after percutaneous coronary intervention. ImportanceThe role of aspirin as part of antiplatelet regimens in acute coronary syndromes (ACS) needs to be clarified in the context of newer potent P2Y12 antagonists. ObjectiveTo evaluate the benefit and risks of aspirin in addition to ticagrelor among patients with ACS beyond 1 month after percutaneous coronary intervention (PCI). Design, Setting, and ParticipantsThis is a nonprespecified, post hoc analysis of GLOBAL LEADERS, a randomized, open-label superiority trial comparing 2 antiplatelet treatment strategies after PCI. The trial included 130 secondary/tertiary care hospitals in different countries, with 15991 unselected patients with stable coronary artery disease or ACS undergoing PCI. Patients had outpatient visits at 1, 3, 6, 12, 18, and 24 months after index procedure. InterventionsThe experimental group received aspirin plus ticagrelor for 1 month followed by 23-month ticagrelor monotherapy; the reference group received aspirin plus either clopidogrel (stable coronary artery disease) or ticagrelor (ACS) for 12 months, followed by 12-month aspirin monotherapy. In this analysis, we examined the clinical outcomes occurring between 31 days and 365 days after randomization, specifically in patients with ACS who, within this time frame, were assigned to receive either ticagrelor alone or ticagrelor and aspirin. Main Outcomes and MeasuresThe primary outcome was the composite of all-cause death or new Q-wave myocardial infarction. ResultsOf 15968 participants, there were 7487 patients with ACS enrolled; 3750 patients were assigned to the experimental group and 3737 patients to the reference group. Between 31 and 365 days after randomization, the primary outcome occurred in 55 patients (1.5%) in the experimental group and in 75 patients (2.0%) in the reference group (hazard ratio [HR], 0.73; 95% CI, 0.51-1.03; P=.07); investigator-reported Bleeding Academic Research Consortium-defined bleeding type 3 or 5 occurred in 28 patients (0.8%) in the experimental group and in 54 patients (1.5%) in the reference arm (HR, 0.52; 95% CI, 0.33-0.81; P=.004). Conclusions and RelevanceBetween 1 month and 12 months after PCI in ACS, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. These findings should be interpreted as exploratory and hypothesis generating; however, they pave the way for further trials evaluating aspirin-free antiplatelet strategies after PCI. Trial RegistrationClinicalTrials.gov identifier: NCT01813435. This secondary analysis of the GLOBAL LEADERS randomized clinical trial evaluates the benefit and risks of aspirin in addition to ticagrelor among patients with acute coronary syndrome beyond 1 month after percutaneous coronary intervention.
Subject: Clopidogrel
Country: Estados Unidos
Editor: American Medical Association
Rights: Fechado
Identifier DOI: 10.1001/jamacardio.2019.3355
Address: https://jamanetwork.com/journals/jamacardiology/article-abstract/2752077
Date Issue: 2019
Appears in Collections:FCM - Artigos e Outros Documentos

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