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Dabigatran Dual Therapy Versus Warfarin Triple Therapy Post-PCI in Patients With Atrial Fibrillation and Diabetes
Aarhus Univ Hosp, Aarhus, Denmark.
Hop Bichat Claude Bernard, FACT, DHU FIRE, Paris, France;Univ Paris Diderot, Paris, France;INSERM, U1148, Paris, France;Hop Bichat Claude Bernard, AP HP, Paris, France.
Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA;Harvard Med Sch, Heart & Vasc Ctr, Boston, MA 02115 USA.
Goethe Univ Frankfurt, Frankfurt, Germany.
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2019 (English)In: JACC: Cardiovascular Interventions, ISSN 1936-8798, E-ISSN 1876-7605, Vol. 12, no 23, p. 2346-2355Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to evaluate dabigatran dual therapy versus warfarin triple therapy in patients with or without diabetes mellitus in the RE-DUAL PCI (Randomized Evaluation of Dual Antithrombotic Therapy With Dabigatran Versus Triple Therapy With Warfarin in Patients With Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) trial.

BACKGROUND: It is unclear whether dual therapy is as safe and efficacious as triple therapy in patients with atrial fibrillation with diabetes following percutaneous coronary intervention.

METHODS: In RE-DUAL PCI, 2,725 patients with atrial fibrillation (993 with diabetes) who had undergone PCI were assigned to warfarin triple therapy (warfarin, clopidogrel or ticagrelor, and aspirin) or dabigatran dual therapy (dabigatran 110 mg or 150 mg twice daily and clopidogrel or ticagrelor). Median follow-up was 13 months. The primary outcome was the composite of major bleeding or clinically relevant nonmajor bleeding, and the main efficacy outcome was the composite of death, thromboembolic events, or unplanned revascularization.

RESULTS: Among patients with diabetes, the incidence of major bleeding or clinically relevant nonmajor bleeding was 15.2% in the dabigatran 110 mg dual therapy group versus 27.5% in the warfarin triple therapy group (hazard ratio [HR]: 0.48; 95% confidence interval [CI] 0.35 to 0.67) and 23.8% in the dabigatran 150 mg dual therapy group versus 25.1% in the warfarin triple therapy group (HR: 0.87; 95% CI: 0.62 to 1.22). Risk for major bleeding or clinically relevant nonmajor bleeding was also reduced with both dabigatran doses among patients without diabetes (dabigatran 110 mg dual therapy: HR: 0.54; 95% CI: 0.42 to 0.70; dabigatran 150 mg dual therapy: HR: 0.63; 95% CI: 0.48 to 0.83). Risk for the efficacy endpoint was comparable between treatment groups for both patients with and those without diabetes. No interaction between treatment and diabetes subgroup could be observed, either for bleeding or for composite efficacy endpoints.

CONCLUSIONS: In this subgroup analysis, dabigatran dual therapy had a lower risk for bleeding and a comparable rate of the efficacy endpoint compared with warfarin triple therapy in patients with atrial fibrillation with or without diabetes following percutaneous coronary intervention. 

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2019. Vol. 12, no 23, p. 2346-2355
Keywords [en]
dabigatran, percutaneous coronary intervention, RE-DUAL PCI, warfarin
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-400430DOI: 10.1016/j.jcin.2019.07.059ISI: 000500696600006PubMedID: 31806216OAI: oai:DiVA.org:uu-400430DiVA, id: diva2:1381228
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2019-12-20Bibliographically approved

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