Causes of late mortality with dual antiplatelet therapy after coronary stents.

Mauri, Laura; Elmariah, Sammy; Yeh, Robert W; Cutlip, Donald E; Steg, P Gabriel; Windecker, Stephan; Wiviott, Stephen D; Cohen, David J; Massaro, Joseph M; D'Agostino, Ralph B; Braunwald, Eugene; Kereiakes, Dean J (2016). Causes of late mortality with dual antiplatelet therapy after coronary stents. European Heart Journal, 37(4), pp. 378-385. Oxford University Press 10.1093/eurheartj/ehv614

Preview

Text 378.full.pdf - Published Version Available under License Publisher holds Copyright. Download (346kB) | Preview

AIMS

In the dual antiplatelet therapy (DAPT) study, continued thienopyridine beyond 12 months after drug-eluting stent placement was associated with increased mortality compared with placebo. We sought to evaluate factors related to mortality in randomized patients receiving either drug-eluting or bare metal stents in the DAPT study.

METHODS AND RESULTS

Patients were enrolled after coronary stenting, given thienopyridine and aspirin for 12 months, randomly assigned to continued thienopyridine or placebo for an additional 18 months (while taking aspirin), and subsequently treated with aspirin alone for another 3 months. A blinded independent adjudication committee evaluated deaths. Among 11 648 randomized patients, rates of all-cause mortality rates were 1.9 vs. 1.5% (continued thienopyridine vs. placebo, P = 0.07), cardiovascular mortality, 1.0 vs. 1.0% (P = 0.97), and non-cardiovascular mortality, 0.9 vs. 0.5% (P = 0.01) over the randomized period (Months 12-30). Rates of fatal bleeding were 0.2 vs. 0.1% (P = 0.81), and deaths related to any prior bleeding were 0.3 vs. 0.2% (P = 0.36), Months 12-33). Cancer incidence did not differ (2.0 vs. 1.6%, P = 0.12). Cancer-related deaths occurred in 0.6 vs. 0.3% (P = 0.02) and were rarely related to bleeding (0.1 vs. 0, P = 0.25). After excluding those occurring in patients with cancer diagnosed before enrolment, rates were 0.4 vs. 0.3% (P = 0.16).

CONCLUSION

Bleeding accounted for a minority of deaths among patients treated with continued thienopyridine. Cancer-related death in association with thienopyridine therapy was mainly not related to bleeding and may be a chance finding. Caution is warranted when considering extended thienopyridine in patients with advanced cancer.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00977938.

Interest & Impact

Downloads

9 since deposited on 09 Mar 2016
7 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item