We compared outcomes of 10 213 patients with
myocardial infarction who underwent
percutaneous coronary intervention and were discharged on dual-antiplatelet
therapy at 228 US hospitals in the Treatment with
ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after
Acute Coronary Syndrome (TRANSLATE-ACS) study from 2010 to 2012. Major adverse cardiovascular events and
bleeding within 6 months postdischarge were compared between high-dose (325 mg) and low-dose
aspirin (81 mg) by using regression models with inverse probability-weighted propensity adjustment. Overall, 6387 patients (63%) received high-dose
aspirin at discharge. Major adverse cardiovascular events risk was not significantly different between groups (high versus low: unadjusted 8.2% versus 9.2%; adjusted hazard ratio, 0.99; 95% confidence interval, 0.85-1.17). High-dose
aspirin use was associated with greater risk of any
Bleeding Academic Research Consortium-defined
bleeding events (unadjusted 24.2% versus 22.7%; adjusted odds ratio, 1.19; 95% confidence interval, 1.06-1.33), driven mostly by minor
Bleeding Academic Research Consortium type 1 or 2
bleeding events not requiring hospitalization (unadjusted 21.4% versus 19.5%; adjusted odds ratio, 1.19; 95% confidence interval, 1.05-1.34).
Bleeding events requiring hospitalization were similar by
aspirin dosing groups (unadjusted 2.8% versus 3.2%, adjusted odds ratio, 1.22; 95% confidence interval, 0.87-1.70). Similar associations were observed in landmark analyses accounting for
aspirin dosing change over time, and across subgroup analyses by age, sex, baseline
aspirin use, and type of
ADP receptor inhibitor (
clopidogrel versus
prasugrel/
ticagrelor).
CONCLUSIONS: