Benefit-risk assessment tilts toward low-dose aspirin after PCI

An analysis of TRANSLATE-ACS data supports current guideline recommendations to prescribe low-dose aspirin to patients who underwent PCI and received dual antiplatelet therapy. The study was published online May 20 in Circulation.

TRANSLATE-ACS (ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) was a prospective, observational study that enrolled STEMI and non-STEMI patients who received PCI between 2010 and 2012 and were treated with ADP receptor inhibitors. Ying Xian, MD, PhD, of the Duke Clinical Research Institute in Durham, N.C., and colleagues assessed data on 10,213 TRANSLATE-ACS patients at 228 U.S. hospitals for their study.

They divided patients into two groups, based on aspirin dosage: high dose (325 mg daily) and low dose (81 mg daily). The American Heart Association/American College of Cardiology guidelines favor low-dose aspirin, but the available data is limited, Xian et al wrote.

They looked at major adverse cardiovascular events (MACE), defined as the composite of death, MI, stroke or unplanned revascularization, and bleeding events as defined by the Bleeding Academic Research Consortium (BARC). The majority of patients—62.6 percent— were on high-dose aspirin treatment. Some hospitals prescribed all and some none of their patients to high-dose aspirin.

At six-months after discharge, the incidence of MACE was 8.2 percent in the high-dose group vs. 9.2 percent in the low-dose group. They found no significant differences in multivariable adjustments. They found no significant differences in MACE in a subgroup analysis as well.

The unadjusted rate of any BARC bleeding was higher in the high-dose group (24.2 percent vs. 22.7 percent in the low-dose group). In adjusted analyses, the odds of experiencing any bleeding event were higher for patients in the high-dose group, mostly driven by an increased risk in minor BARC bleeding not requiring hospitalization.

The findings support current guidelines and highlight the variability in aspirin dosing in the U.S., they wrote. “This large variation in practice underscores the paucity of comparative data to guide appropriate dosing of aspirin after PCI.”