Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

In patients with coronavirus disease 2019 (COVID-19), the conventional coagulation abnormalities mimic those of other systemic coagulopathies that are associated with severe infections, such as disseminated intravascular coagulation, but the disease also has some distinct features 1,2 . Deep-vein thrombosis and pulmonary embolism are frequently found in patients with COVID-19; the incidence depends on whether routine (ultrasonography) screening is instituted and the severity of the disease, with a higher prevalence in patients in the intensive care unit (ICU) [3][4][5] . In a meta-analysis of 49 studies, including 18,093 patients, the reported pooled incidence of venous thromboembolism (VTE) was 17.0%, with an incidence of 33.0% in studies that used systematic screening (28% of studies) and an incidence of 9.8% in those relying on clinical diagnosis 6 . Large, randomized, controlled trials in hospitalized patients with COVID-19, which did not screen for VTE, have found a lower incidence of VTE of 6-10% when prophylacticdose anticoagulation was used and an incidence of 4-8% when treatment-dose anticoagulation was used 7-9 . In patients with COVID-19 in the ICU, systematic reviews suggest an incidence of VTE of 28%, although the latest reviews suggest an incidence of 19-24% when clinical diagnosis is used and 36-46% when routine screening is used 10,11 .Superficial-vein thrombosis and catheter-related thrombosis in patients with COVID-19 are also frequently reported 12 . Akin to venous thrombosis, arterial thrombosis can affect all organs, with ischaemic

Background— There is a paucity of data from large cohort studies examining the prognostic significance of obstructive sleep apnea (OSA) in patients with coronary artery disease. We hypothesized that OSA predicts subsequent major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing percutaneous coronary intervention. Methods and Results— The Sleep and Stent Study was a prospective, multicenter registry of patients successfully treated with percutaneous coronary intervention in 5 countries. Between December 2011 and April 2014, 1748 eligible patients were prospectively enrolled. The 1311 patients who completed a sleep study within 7 days of percutaneous coronary intervention formed the cohort for this analysis. Drug-eluting stents were used in 80.1% and bioresorbable vascular scaffolds in 6.3% of the patients, and OSA, defined as an apnea-hypopnea index of ≥15 events per hour, was found in 45.3%. MACCEs, a composite of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and unplanned revascularization, occurred in 141 patients during the median follow-up of 1.9 years (interquartile range, 0.8 years). The crude incidence of an MACCEs was higher in the OSA than the non-OSA group (3-year estimate, 18.9% versus 14.0%; p =0.001). Multivariate Cox regression analysis indicated that OSA was a predictor of MACCEs, with an adjusted hazard ratio of 1.57 (95% confidence interval, 1.10–2.24; P =0.013), independently of age, sex, ethnicity, body mass index, diabetes mellitus, and hypertension. Conclusions— OSA is independently associated with subsequent MACCEs in patients undergoing percutaneous coronary intervention. Evaluation of therapeutic approaches to mitigate OSA-associated risk is warranted. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01306526.