September 26, 2008European Heart Journal
Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study
Why the study?
Due to a paucity of data, the optimal dose of aspirin in the setting of percutaneous coronary intervention is uncertain.
Does low-dose aspirin reduce major bleeding without increasing ischemic events compared to higher doses in patients with acute coronary syndromes undergoing PCI?
Structured PICO
Does low-dose aspirin reduce major bleeding without increasing ischemic events compared to higher doses in patients with acute coronary syndromes undergoing PCI?
P
Population
2,658 patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI)
I
Intervention
High-dose (≥200 mg) or moderate-dose (101-199 mg) aspirin
C
Comparator
Low-dose (≤100 mg) aspirin
O
Outcome
Composite of cardiovascular death, myocardial infarction, or stroke (efficacy) and major bleeding (safety)composite
Low-dose aspirin (≤100 mg) is as effective as higher doses for preventing ischemic events after PCI but is associated with significantly less major bleeding.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This analysis suggests low-dose aspirin may be superior with regard to a lower rate of serious bleeding compared to high-dose aspirin, and with similar efficacy in terms of death, MI, and stroke.”
Implication
Supports low-dose aspirin post-PCI to limit bleeding; leaves open optimal dose pending dedicated randomized trials.
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.
Discussion
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Cite This Study
Jolly et al. (2008) studied this question.