Aspirin Dosing for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Patients Treated With P2Y12 Inhibitors

Author:

Girotra Saket1ORCID,Stebbins Amanda2ORCID,Wruck Lisa2ORCID,Marquis‐Gravel Guillaume3ORCID,Gupta Kamal4ORCID,Farrehi Peter5ORCID,Benziger Catherine P.6ORCID,Effron Mark B.7ORCID,Whittle Jeffrey8ORCID,Muñoz Daniel9ORCID,Kripalani Sunil9ORCID,Anderson R. David10ORCID,Jain Sandeep K.11ORCID,Polonsky Tamar S.12ORCID,Ahmad Faraz S.13ORCID,Roe Matthew T.2,Rothman Russell L.9ORCID,Harrington Robert A.14ORCID,Hernandez Adrian F.2ORCID,Jones W. Schuyler2ORCID

Affiliation:

1. University of Texas Southwestern Medical Center Dallas TX

2. Duke University Medical Center and Duke Clinical Research Institute Durham NC

3. Université de Montréal Montreal QC Canada

4. University of Kansas Medical Center Kansas City KS

5. University of Michigan Ann Arbor MI

6. Essentia Health Heart and Vascular Center Duluth MN

7. Ochsner Health New Orleans LA

8. Medical College of Wisconsin Milwaukee WI

9. Vanderbilt University Medical Center Nashville TN

10. University of Florida Gainesville FL

11. University of Pittsburg Medical Center Pittsburgh PA

12. University of Chicago Medicine Chicago IL

13. Northwestern University Feinberg School of Medicine Chicago IL

14. Stanford University School of Medicine Stanford CA

Abstract

Background The ADAPTABLE (Aspirin Dosing: A Patient‐Centric Trial Assessing Benefits and Long‐Term Effectiveness) was a large, pragmatic, randomized controlled trial that found no difference between high‐ versus low‐dose aspirin for secondary prevention of atherosclerotic cardiovascular disease. Whether concomitant P2Y12 inhibitor therapy modifies the effect of aspirin dose on clinical events remains unclear. Methods and Results Participants in ADAPTABLE were stratified according to baseline use of clopidogrel or prasugrel (P2Y12 group). The primary effectiveness end point was a composite of death, myocardial infarction, or stroke; and the primary safety end point was major bleeding requiring blood transfusions. We used multivariable Cox regression to compare the relative effectiveness and safety of aspirin dose within P2Y12 and non‐P2Y12 groups. Of 13 815 (91.6%) participants with available data, 3051 (22.1%) were receiving clopidogrel (2849 [93.4%]) or prasugrel (203 [6.7%]) at baseline. P2Y12 inhibitor use was associated with higher risk of the primary effectiveness end point (10.86% versus 6.31%; adjusted hazard ratio [HR], 1.40 [95% CI, 1.22–1.62]) but was not associated with bleeding (0.95% versus 0.53%; adjusted HR, 1.42 [95% CI, 0.91–2.22]). We found no interaction in the relative effectiveness and safety of high‐ versus low‐dose aspirin by P2Y12 inhibitor use. Overall, dose switching or discontinuation was more common in the high‐dose compared with low‐dose aspirin group, but the pattern was not modified by P2Y12 inhibitor use. Conclusions In this prespecified analysis of ADAPTABLE, we found that the relative effectiveness and safety of high‐ versus low‐dose aspirin was not modified by baseline P2Y12 inhibitor use. Registration https://www.clinical.trials.gov . Unique identifier: NCT02697916.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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