HealthDay News – A new prediction rule may inform which patients will see a benefit or harm from dual antiplatelet therapy (DAPT) beyond 1 year after percutaneous coronary intervention (PCI), according to a study published online March 29 in the Journal of the American Medical Association.

Robert W. Yeh, MD, from the Beth Israel Deaconess Medical Center in Boston, and colleagues developed a clinical decision tool to identify patients expected to derive benefit vs harm from continuing thienopyridine beyond 1 year after PCI. The tool was based on stratification of patients participating in the DAPT study and was validated on patients in the PROTECT (Patient-Related Outcomes With Endeavor vs Cypher Stenting) trial.

Researchers found that continued thienopyridine vs placebo was associated with reduced ischemic events (P <.001) in the high-score group (score ≥2; 5917 patients) compared with the low-score group (score <2, 5731 patients; P=.07; interaction P<.001). Conversely, in the high-score group, continued thienopyridine was associated with smaller increases in bleeding (P=.26) compared with the low-score group (P<.001; interaction P=.02). However, among PROTECT patients in the validation cohort, the high-score patients (2848) had increased ischemic events compared with the low-score patients, and no significant difference in bleeding.


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“Among patients not sustaining major bleeding or ischemic events 1 year after PCI, a prediction rule assessing late ischemic and bleeding risks to inform dual antiplatelet therapy duration showed modest accuracy in derivation and validation cohorts,” the authors wrote.

Reference

Yeh RW, Secemsky EA, Kereiakes DJ, et al; for the DAPT study investigators. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA. doi:10.1001/jama.2016.3775.