Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention

Yeh, Robert W.; Secemsky, Eric A.; Kereiakes, Dean J.; Normand, Sharon‐Lise T.; Gershlick, Anthony; Cohen, David J.; Spertus, John A.; Steg, Philippe Gabriel; Cutlip, Donald E.; Rinaldi, Michael; Camenzind, Edoardo; Wijns, William; Apruzzese, Patricia; Song, Yang; Massaro, Joseph M.; Mauri, Laura

doi:10.1001/jama.2016.3775

Cited by 814 publications

(613 citation statements)

References 30 publications

Supporting

Mentioning

556

Contrasting

Unclassified

Order By: Relevance

“…7 In a substudy of the DAPT trial, a risk score to guide these decisions was proposed, although this used age as the only indicator of bleeding risk without providing any estimate of the discriminatory ability of the final model. 26 In the present study, the bleeding signal captured by GDF-15 levels provided incremental information beyond age and other clinical factors, both before start of treatment in the acute phase and when repeated during DAPT treatment in the chronic phase.…”

Section: Discussionmentioning

confidence: 68%

Growth Differentiation Factor 15 Predicts All-Cause Morbidity and Mortality in Stable Coronary Heart Disease

et al. 2017

Self Cite

View full text Add to dashboard Cite

Background--Growth differentiation factor-15 (GDF-15) is related to major bleeding when measured at initial presentation in patients with acute coronary syndromes (ACSs) treated with dual antiplatelet therapy. It is unknown whether follow-up measurements provide additional information. The objective of this study was to investigate whether GDF-15 measured 1 month after an ACS provides additional information beyond the baseline levels with regard to the risk of major bleeding.

show abstract

Section: Discussionmentioning

confidence: 68%

Growth Differentiation Factor 15 Predicts All-Cause Morbidity and Mortality in Stable Coronary Heart Disease

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…The latter point has been underscored in recent studies developing and validating a clinical prediction tool, the 'DAPT score', to provide an accurate tool for the assessment of the relative benefit-to-risk profile for L-DAPT vs. S-DAPT. A high DAPT score (≥2) predicts ischemic benefit without incremental bleeding risk with L-DAPT [32][33].…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, older age contributes to a lower (less favorable) DAPT score [29,[32][33] Additional factors that may need to be considered are stent type/generation, drug availability, and patient preference. Newer-generation DES have a lower risk of stent thrombosis and appear to require a shorter minimum duration of DAPT [4,6,7,34,35].…”

Section: Resultsmentioning

confidence: 99%

Duration of dual antiplatelet therapy following drug‐eluting stent implantation: A systemic review and meta‐analysis of randomized controlled trials with longer follow up

Sharma

Agrawal

Garg

et al. 2017

Cathet Cardio Intervent

View full text Add to dashboard Cite

Objective To evaluate the long term efficacy and safety of long duration DAPT (L‐DAPT) compared to short duration DAPT (S‐DAPT) after drug‐eluting stent (DES) implantation. Methods We searched Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials (RCTs) assessing the clinical impact of L‐DAPT versus S‐DAPT after DES and have mean follow up period of at least 2 years or longer. Primary end point was stent thrombosis (ST). Secondary endpoints were all‐cause mortality, cardiac mortality, myocardial infarction (MI), target vessel revascularization (TVR), thrombolysis in myocardial infarction (TIMI) major bleeding and stroke. Event rates were compared using a random effects model. Results We identified five RCTs in which 19,760 patients were randomized to S‐DAPT (N = 9,810) and L‐DAPT (n = 9,950), respectively. Compared with L‐DAPT, S‐DAPT was associated with higher rate of MI (odds ratio [OR] 1.48, 95% confidence interval [CI] [1.04, 2.10]). There were no significant differences between S‐DAPT and L‐DAPT in terms of all cause mortality, cardiac mortality, ST, TVR or stroke (OR 0.90, 95% CI [0.73, 1.12]; OR 1.02, 95% CI [0.80, 1.30]; OR 1.59, 95% CI [0.77, 3.27]; OR 0.87 95% CI [0.67, 1.14]; and OR 1.08 95% CI [0.81, 1.46], respectively). However, rate of TIMI major bleeding was significantly lower with S‐DAPT compared to L‐DAPT (OR 0.64, 95% CI [0.41, 0.99]). Conclusions In the present analysis of RCTs with longer follow up (2 years or longer), S‐DAPT compared with L‐DAPT, was associated with higher rate of MI and lower rate of major bleeding without any significant difference in the rates of all cause mortality, cardiac mortality, ST, TVR, and stroke.

show abstract

“…Specific scores stratifying bleeding or ischemic risks after stent implantation have also been created (16,17). Most recently, the DAPT score is the first clinical tool that simultaneously stratifies bleeding and ischemic risks, helping to identify patients that are expected to benefit the most from extending dual anti-platelet therapy after stent implantation beyond 12 months, as well as those likely to be harmed ( Table 1) (18). The DAPT score was explicitly identified in the new guidelines as a tool to help clinicians sort through the class IIb recommendations that recommend selective use of longer or shorter durations of DAPT based on individual patient profiles.…”

Section: Personalized Over Dogmatic Approachmentioning

confidence: 99%

Duration of dual antiplatelet therapy (DAPT): a call for personalized medicine

Tahir

Yeh

2016

J. Thorac. Dis.

Self Cite

View full text Add to dashboard Cite

Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention

Cited by 814 publications

References 30 publications

Growth Differentiation Factor 15 Predicts All-Cause Morbidity and Mortality in Stable Coronary Heart Disease

Growth Differentiation Factor 15 Predicts All-Cause Morbidity and Mortality in Stable Coronary Heart Disease

Duration of dual antiplatelet therapy following drug‐eluting stent implantation: A systemic review and meta‐analysis of randomized controlled trials with longer follow up

Duration of dual antiplatelet therapy (DAPT): a call for personalized medicine

Contact Info

Product

Resources

About