Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study.

Abstract

AIMS:

In the setting of percutaneous coronary intervention (PCI), due to a paucity of data, the optimal dose of aspirin is uncertain. We evaluated the safety of different doses of aspirin after PCI.

METHODS AND RESULTS:

In the PCI-CURE study, 2658 patients with acute coronary syndromes undergoing PCI were stratified into three aspirin dose groups >/=200 mg (high, n = 1064), 101-199 mg (moderate, n = 538), and </=100 mg (low, n = 1056). For efficacy, the moderate- (7.4%) and high-dose groups (8.6%) had similar rates of cardiovascular death, myocardial infarction, or stroke compared with the low-dose group (7.1%). For safety, major bleeding was increased with high-dose aspirin [3.9, 1.5, and 1.9% in the high-, moderate-, and low-dose groups; hazard ratio (HR) of high vs. low dose 2.05 (95% CI 1.20-3.50, P = 0.009]. The net adverse clinical events (death, MI, stroke, major bleeding) favoured low-over high-dose aspirin (8.4 vs. 11.0%, HR 1.31, 95% CI 1.00-1.73 P = 0.056).

CONCLUSION:

In this large observational analysis of patients undergoing PCI, low-dose aspirin appeared to be as effective as higher doses in preventing ischaemic events but was also associated with a lower rate of major bleeding and an improved net efficacy to safety balance.

• Authors: Sanjit S Jolly, Janice Pogue, Kimberly Haladyn, Ron J G Peters, Keith A A Fox, Alvaro Avezum, Bernard J Gersh, Hans Jurgen Rupprecht, Salim Yusuf, Shamir R Mehta
• Journal: European heart journal (Eur Heart J) Vol. 30 Issue 8 Pg. 900-7 (Apr 2009) ISSN: 1522-9645 [Electronic] England
• PMID: 18819961 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticlopidine
• Aspirin

Topics

• Angioplasty, Balloon, Coronary (mortality)
• Aspirin (administration & dosage, adverse effects)
• Clopidogrel
• Death, Sudden, Cardiac (etiology)
• Double-Blind Method
• Female
• Hemorrhage (chemically induced, mortality)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (mortality, therapy)
• Myocardial Ischemia (prevention & control)
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Stroke (mortality, prevention & control)
• Ticlopidine (administration & dosage, analogs & derivatives)
• Treatment Outcome