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Frequency of the Use of Low- Versus High-Dose Aspirin in Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (from the Dual Antiplatelet Therapy Study)
In randomized trials, low-dose (LD) and high-dose (HD) aspirin (ASA) are equally effective in reducing ischemic complications, but HD ASA is associated with an increased risk of bleeding in the setting of dual antiplatelet therapy after percutaneous coronary intervention (PCI). ASA dose after PCI va...
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Published in: | The American journal of cardiology 2014-04, Vol.113 (7), p.1146-1152 |
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creator | Matteau, Alexis, MD, MSc Yeh, Robert W., MD, MBA Kereiakes, Dean, MD Orav, E. John, PhD Massaro, Joseph, PhD Steg, P. Gabriel, MD Normand, Sharon-Lise, PhD Cutlip, Donald E., MD Mauri, Laura, MD, MSc |
description | In randomized trials, low-dose (LD) and high-dose (HD) aspirin (ASA) are equally effective in reducing ischemic complications, but HD ASA is associated with an increased risk of bleeding in the setting of dual antiplatelet therapy after percutaneous coronary intervention (PCI). ASA dose after PCI varies across countries, but little is known about variation within the United States (US) and whether this variation can be explained by clinical characteristics of patients. We used enrollment data from the Dual Antiplatelet Therapy Study, a randomized trial designed to compare 12 versus 30 months of dual antiplatelet therapy after PCI, to quantify the variation in ASA dosing after PCI in the US subjects and assess the extent to which dose variability was attributable to patient characteristics. Of the 23,336 patients enrolled in the US, 28.0% were prescribed LD ASA at discharge after PCI. Patient characteristics explained 1.6% of total variance in ASA dose, whereas the study site accounted for 45.9% of the unexplained variability. The median odds ratio comparing sites was 5.05 (95% confidence interval 4.29 to 5.85), which was greater than any individual predictor of ASA dose. In conclusion, LD ASA after PCI in the US was used in a minority of patients, and heterogeneity in its selection was mainly influenced by the site of enrollment rather than patient characteristics. As HD ASA may be associated with adverse events in the setting of dual antiplatelet therapy, reducing local practice variation in the dose of ASA may be a target for quality improvement. |
doi_str_mv | 10.1016/j.amjcard.2013.10.015 |
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John, PhD ; Massaro, Joseph, PhD ; Steg, P. Gabriel, MD ; Normand, Sharon-Lise, PhD ; Cutlip, Donald E., MD ; Mauri, Laura, MD, MSc</creator><creatorcontrib>Matteau, Alexis, MD, MSc ; Yeh, Robert W., MD, MBA ; Kereiakes, Dean, MD ; Orav, E. John, PhD ; Massaro, Joseph, PhD ; Steg, P. Gabriel, MD ; Normand, Sharon-Lise, PhD ; Cutlip, Donald E., MD ; Mauri, Laura, MD, MSc</creatorcontrib><description>In randomized trials, low-dose (LD) and high-dose (HD) aspirin (ASA) are equally effective in reducing ischemic complications, but HD ASA is associated with an increased risk of bleeding in the setting of dual antiplatelet therapy after percutaneous coronary intervention (PCI). ASA dose after PCI varies across countries, but little is known about variation within the United States (US) and whether this variation can be explained by clinical characteristics of patients. We used enrollment data from the Dual Antiplatelet Therapy Study, a randomized trial designed to compare 12 versus 30 months of dual antiplatelet therapy after PCI, to quantify the variation in ASA dosing after PCI in the US subjects and assess the extent to which dose variability was attributable to patient characteristics. Of the 23,336 patients enrolled in the US, 28.0% were prescribed LD ASA at discharge after PCI. Patient characteristics explained 1.6% of total variance in ASA dose, whereas the study site accounted for 45.9% of the unexplained variability. The median odds ratio comparing sites was 5.05 (95% confidence interval 4.29 to 5.85), which was greater than any individual predictor of ASA dose. In conclusion, LD ASA after PCI in the US was used in a minority of patients, and heterogeneity in its selection was mainly influenced by the site of enrollment rather than patient characteristics. As HD ASA may be associated with adverse events in the setting of dual antiplatelet therapy, reducing local practice variation in the dose of ASA may be a target for quality improvement.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2013.10.015</identifier><identifier>PMID: 24332248</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Aspirin ; Aspirin - administration & dosage ; Binomial distribution ; Blood clots ; Cardiology ; Cardiovascular ; Cardiovascular disease ; Coronary vessels ; Diabetes ; Dose-Response Relationship, Drug ; Drug dosages ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Heart attacks ; Heart failure ; Humans ; Hypertension ; Kidney diseases ; Male ; Middle Aged ; Myocardial Infarction - therapy ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors - administration & dosage ; Postoperative Period ; Pyridines - administration & dosage ; Retrospective Studies ; Stents ; Stroke ; Thrombosis ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 2014-04, Vol.113 (7), p.1146-1152</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 1, 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-b6b4595dd55bf2a371ed90054d6a095c27c5f2d48e5728c25ce223469ce97ce73</citedby><cites>FETCH-LOGICAL-c448t-b6b4595dd55bf2a371ed90054d6a095c27c5f2d48e5728c25ce223469ce97ce73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24332248$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Matteau, Alexis, MD, MSc</creatorcontrib><creatorcontrib>Yeh, Robert W., MD, MBA</creatorcontrib><creatorcontrib>Kereiakes, Dean, MD</creatorcontrib><creatorcontrib>Orav, E. John, PhD</creatorcontrib><creatorcontrib>Massaro, Joseph, PhD</creatorcontrib><creatorcontrib>Steg, P. Gabriel, MD</creatorcontrib><creatorcontrib>Normand, Sharon-Lise, PhD</creatorcontrib><creatorcontrib>Cutlip, Donald E., MD</creatorcontrib><creatorcontrib>Mauri, Laura, MD, MSc</creatorcontrib><title>Frequency of the Use of Low- Versus High-Dose Aspirin in Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (from the Dual Antiplatelet Therapy Study)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>In randomized trials, low-dose (LD) and high-dose (HD) aspirin (ASA) are equally effective in reducing ischemic complications, but HD ASA is associated with an increased risk of bleeding in the setting of dual antiplatelet therapy after percutaneous coronary intervention (PCI). ASA dose after PCI varies across countries, but little is known about variation within the United States (US) and whether this variation can be explained by clinical characteristics of patients. We used enrollment data from the Dual Antiplatelet Therapy Study, a randomized trial designed to compare 12 versus 30 months of dual antiplatelet therapy after PCI, to quantify the variation in ASA dosing after PCI in the US subjects and assess the extent to which dose variability was attributable to patient characteristics. Of the 23,336 patients enrolled in the US, 28.0% were prescribed LD ASA at discharge after PCI. Patient characteristics explained 1.6% of total variance in ASA dose, whereas the study site accounted for 45.9% of the unexplained variability. The median odds ratio comparing sites was 5.05 (95% confidence interval 4.29 to 5.85), which was greater than any individual predictor of ASA dose. In conclusion, LD ASA after PCI in the US was used in a minority of patients, and heterogeneity in its selection was mainly influenced by the site of enrollment rather than patient characteristics. As HD ASA may be associated with adverse events in the setting of dual antiplatelet therapy, reducing local practice variation in the dose of ASA may be a target for quality improvement.</description><subject>Acute coronary syndromes</subject><subject>Aspirin</subject><subject>Aspirin - administration & dosage</subject><subject>Binomial distribution</subject><subject>Blood clots</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Coronary vessels</subject><subject>Diabetes</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug dosages</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - therapy</subject><subject>Percutaneous Coronary Intervention</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Postoperative Period</subject><subject>Pyridines - administration & dosage</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Stroke</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqFUl2L1DAUDaK44-pPUAK-rA8dkzRpmxdlmHXdhQGF3fU1ZNJbJ7VtZpN0pX_I32nqjAoLIgSS3HvuuR_nIvSSkiUltHjbLnXfGu3rJSM0T7YloeIRWtCqlBmVNH-MFoQQlknK5Ql6FkKbvpSK4ik6YTzPGePVAv248HA3wmAm7Bocd4BvA8zPjfue4S_gwxjwpf26y85dcqzC3no74HTOR93h1RDtvtMROoj4Zgde7ye8aiJ4_Bm8GaMewCWGtfNu0H7CV0Py3UMKcwM-a7zrfyX9N9l1HOvpzXP0pNFdgBfH-xTdXny4WV9mm08fr9arTWY4r2K2LbZcSFHXQmwbpvOSQi0JEbwuNJHCsNKIhtW8AlGyyjBhgLGcF9KALA2U-Sk6O_DuvUtjCVH1NhjoukMfigpS8TRDwhP09QNo60Y_pOoULVIVtBTlTCgOKONdCB4atfe2T5NQlKhZSNWqo5BqFnI2JyFT3Ksj-7jtof4T9Vu5BHh_AEAax70Fr4KxSUeorQcTVe3sf1O8e8BgOjtYo7tvMEH4240KTBF1PW_TvEw0J4xyLvOfGhPHLw</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Matteau, Alexis, MD, MSc</creator><creator>Yeh, Robert W., MD, MBA</creator><creator>Kereiakes, Dean, MD</creator><creator>Orav, E. 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John, PhD</au><au>Massaro, Joseph, PhD</au><au>Steg, P. Gabriel, MD</au><au>Normand, Sharon-Lise, PhD</au><au>Cutlip, Donald E., MD</au><au>Mauri, Laura, MD, MSc</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frequency of the Use of Low- Versus High-Dose Aspirin in Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (from the Dual Antiplatelet Therapy Study)</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>113</volume><issue>7</issue><spage>1146</spage><epage>1152</epage><pages>1146-1152</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>In randomized trials, low-dose (LD) and high-dose (HD) aspirin (ASA) are equally effective in reducing ischemic complications, but HD ASA is associated with an increased risk of bleeding in the setting of dual antiplatelet therapy after percutaneous coronary intervention (PCI). ASA dose after PCI varies across countries, but little is known about variation within the United States (US) and whether this variation can be explained by clinical characteristics of patients. We used enrollment data from the Dual Antiplatelet Therapy Study, a randomized trial designed to compare 12 versus 30 months of dual antiplatelet therapy after PCI, to quantify the variation in ASA dosing after PCI in the US subjects and assess the extent to which dose variability was attributable to patient characteristics. Of the 23,336 patients enrolled in the US, 28.0% were prescribed LD ASA at discharge after PCI. Patient characteristics explained 1.6% of total variance in ASA dose, whereas the study site accounted for 45.9% of the unexplained variability. The median odds ratio comparing sites was 5.05 (95% confidence interval 4.29 to 5.85), which was greater than any individual predictor of ASA dose. In conclusion, LD ASA after PCI in the US was used in a minority of patients, and heterogeneity in its selection was mainly influenced by the site of enrollment rather than patient characteristics. As HD ASA may be associated with adverse events in the setting of dual antiplatelet therapy, reducing local practice variation in the dose of ASA may be a target for quality improvement.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24332248</pmid><doi>10.1016/j.amjcard.2013.10.015</doi><tpages>7</tpages></addata></record> |
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subjects | Acute coronary syndromes Aspirin Aspirin - administration & dosage Binomial distribution Blood clots Cardiology Cardiovascular Cardiovascular disease Coronary vessels Diabetes Dose-Response Relationship, Drug Drug dosages Drug Therapy, Combination Female Follow-Up Studies Heart attacks Heart failure Humans Hypertension Kidney diseases Male Middle Aged Myocardial Infarction - therapy Percutaneous Coronary Intervention Platelet Aggregation Inhibitors - administration & dosage Postoperative Period Pyridines - administration & dosage Retrospective Studies Stents Stroke Thrombosis Treatment Outcome |
title | Frequency of the Use of Low- Versus High-Dose Aspirin in Dual Antiplatelet Therapy After Percutaneous Coronary Intervention (from the Dual Antiplatelet Therapy Study) |
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