Dabigatran Dual Therapy vs Warfarin Triple Therapy Post-Percutaneous Coronary Intervention in Patients with Atrial Fibrillation With/Without a Proton Pump Inhibitor: ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2020-06-19

AUTHORS

José C. Nicolau, Deepak L. Bhatt, Stefan H. Hohnloser, Takeshi Kimura, Gregory Y. H. Lip, Corinna Miede, Matias Nordaby, Jonas Oldgren, Philippe Gabriel Steg, Jurriën M. ten Berg, Lucas C. Godoy, Christopher P. Cannon

ABSTRACT

Background and ObjectiveIn patients with atrial fibrillation following percutaneous coronary intervention, if a proton pump inhibitor is used, could that allow the use of warfarin triple therapy, or is there additional reduction in bleeding while using it with dual therapy?MethodsThe RE-DUAL PCI trial randomized 2725 patients with atrial fibrillation post-percutaneous coronary intervention to dabigatran dual therapy (110 or 150 mg twice daily, with clopidogrel or ticagrelor) or warfarin triple therapy (with clopidogrel or ticagrelor, and aspirin for 1–3 months). This prespecified subgroup analysis evaluated risks of a first major bleeding event or clinically relevant non-major bleeding event, all gastrointestinal bleeding, and a composite efficacy endpoint of all-cause mortality/thromboembolic event or unplanned revascularization according to baseline use of a proton pump inhibitor.ResultsOf 2678 analyzed patients, 1641 (61.3%) were receiving a proton pump inhibitor at baseline. Dabigatran 110 and 150 mg dual therapy reduced the risk of major bleeding events or clinically relevant non-major bleeding events vs warfarin triple therapy regardless of proton pump inhibitor use, with comparable risk of the composite efficacy endpoint (all interaction p values > 0.05). For gastrointestinal bleeding, no interaction was observed between study treatment and proton pump inhibitor use (interaction p values 0.84 and 0.62 for dabigatran 110 and 150 mg dual therapy, respectively, vs warfarin triple therapy).ConclusionsDabigatran 110 and 150 mg dual therapy reduced the risk of major bleeding events or clinically relevant non-major bleeding events vs warfarin triple therapy, regardless of proton pump inhibitor use at baseline, in patients with atrial fibrillation who underwent percutaneous coronary intervention. Risk of the composite efficacy endpoint appeared to be similar for dabigatran dual therapy vs warfarin triple therapy in patients receiving/not receiving a proton pump inhibitor.ClinicalTrials.gov unique identifierNCT02164864.Video abstract9bCJcyECW5ZhWkqtD4e3HH More... »

PAGES

995-1005

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s40265-020-01323-x

DOI

http://dx.doi.org/10.1007/s40265-020-01323-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1128623324

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32562206


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