أعرض في EDS

Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations

التفاصيل البيبلوغرافية
العنوان: Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations
المؤلفون: Anoop D. Shah, Eleni Rapsomaniki, Harry Hemingway, Alireza Moayyeri, Dimitris Stogiannis, Sheng-Chia Chung, Mar Pujades-Rodriguez, C Emmas, Laura Pasea, Adam Timmis, Spiros Denaxas
المصدر: The BMJ
بيانات النشر: BMJ Publishing Group Ltd., 2016.
سنة النشر: 2016
مصطلحات موضوعية: Male, medicine.medical_specialty, Ticagrelor, Adenosine, Time Factors, Population, Myocardial Infarction, Coronary Disease, Hemorrhage, 030204 cardiovascular system & hematology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Cause of Death, medicine, Secondary Prevention, Electronic Health Records, Humans, 030212 general & internal medicine, Myocardial infarction, education, Stroke, Aged, Aged, 80 and over, education.field_of_study, Clinical Trials as Topic, Aspirin, business.industry, Research, General Medicine, Middle Aged, medicine.disease, 3. Good health, Surgery, Cardiovascular Diseases, Relative risk, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, business, TIMI, Platelet Aggregation Inhibitors, Cohort study, medicine.drug
الوصف: Objective To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials. Design Observational population based cohort study. Setting PEGASUS-TIMI-54 trial population and CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records). Participants 7238 patients who survived a year or more after acute myocardial infarction. Interventions Prolonged dual antiplatelet therapy after acute myocardial infarction. Main outcome measures Recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease. Fatal, severe, or intracranial bleeding. Results 1676/7238 (23.1%) patients met trial inclusion and exclusion criteria (“target” population). Compared with the placebo arm in the trial population, in the target population the median age was 12 years higher, there were more women (48.6% v 24.3%), and there was a substantially higher cumulative three year risk of both the primary (benefit) trial endpoint of recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease (18.8% (95% confidence interval 16.3% to 21.8%) v 9.04%) and the primary (harm) endpoint of fatal, severe, or intracranial bleeding (3.0% (2.0% to 4.4%) v 1.26% (TIMI major bleeding)). Application of intention to treat relative risks from the trial (ticagrelor 60 mg daily arm) to CALIBER’s target population showed an estimated 101 (95% confidence interval 87 to 117) ischaemic events prevented per 10 000 treated per year and an estimated 75 (50 to 110) excess fatal, severe, or intracranial bleeds caused per 10 000 patients treated per year. Generalisation from CALIBER’s target subgroup to all 7238 real world patients who were stable at least one year after acute myocardial infarction showed similar three year risks of ischaemic events (17.2%, 16.0% to 18.5%), with an estimated 92 (86 to 99) events prevented per 10 000 patients treated per year, and similar three year risks of bleeding events (2.3%, 1.8% to 2.9%), with an estimated 58 (45 to 73) events caused per 10 000 patients treated per year. Conclusions This novel use of primary-secondary care linked electronic health records allows characterisation of “healthy trial participant” effects and confirms the potential absolute benefits and harms of dual antiplatelet therapy in representative patients a year or more after acute myocardial infarction.
اللغة: English
تدمد: 1756-1833
0959-8138
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dfd17763995f11fe3cb46ed89a07e357
http://europepmc.org/articles/PMC4916922
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....dfd17763995f11fe3cb46ed89a07e357
قاعدة البيانات: OpenAIRE
الوصف
تدمد:17561833
09598138