Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations
Objective To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials.Design Observational population based cohort study.Setting PEGASU...
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| Veröffentlicht in: | BMJ (Online) 2016-06, Vol.353, p.i3163 |
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| creator | Timmis, A Rapsomaniki, E Chung, S C Pujades-Rodriguez, M Moayyeri, A Stogiannis, D Shah, A D Pasea, L Denaxas, S Emmas, C Hemingway, H |
| description | Objective To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials.Design Observational population based cohort study.Setting PEGASUS-TIMI-54 trial population and CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).Participants 7238 patients who survived a year or more after acute myocardial infarction.Interventions Prolonged dual antiplatelet therapy after acute myocardial infarction.Main outcome measures Recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease. Fatal, severe, or intracranial bleeding.Results 1676/7238 (23.1%) patients met trial inclusion and exclusion criteria (“target” population). Compared with the placebo arm in the trial population, in the target population the median age was 12 years higher, there were more women (48.6% v 24.3%), and there was a substantially higher cumulative three year risk of both the primary (benefit) trial endpoint of recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease (18.8% (95% confidence interval 16.3% to 21.8%) v 9.04%) and the primary (harm) endpoint of fatal, severe, or intracranial bleeding (3.0% (2.0% to 4.4%) v 1.26% (TIMI major bleeding)). Application of intention to treat relative risks from the trial (ticagrelor 60 mg daily arm) to CALIBER’s target population showed an estimated 101 (95% confidence interval 87 to 117) ischaemic events prevented per 10 000 treated per year and an estimated 75 (50 to 110) excess fatal, severe, or intracranial bleeds caused per 10 000 patients treated per year. Generalisation from CALIBER’s target subgroup to all 7238 real world patients who were stable at least one year after acute myocardial infarction showed similar three year risks of ischaemic events (17.2%, 16.0% to 18.5%), with an estimated 92 (86 to 99) events prevented per 10 000 patients treated per year, and similar three year risks of bleeding events (2.3%, 1.8% to 2.9%), with an estimated 58 (45 to 73) events caused per 10 000 patients treated per year.Conclusions This novel use of primary-secondary care linked electronic health records allows characterisation of “healthy trial participant” effects and confirms the potential absolute benefits and harms of dual antiplatelet therapy in representative patients a year or more after acute myocardial infarction. |
| doi_str_mv | 10.1136/bmj.i3163 |
| format | Article |
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Fatal, severe, or intracranial bleeding.Results 1676/7238 (23.1%) patients met trial inclusion and exclusion criteria (“target” population). Compared with the placebo arm in the trial population, in the target population the median age was 12 years higher, there were more women (48.6% v 24.3%), and there was a substantially higher cumulative three year risk of both the primary (benefit) trial endpoint of recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease (18.8% (95% confidence interval 16.3% to 21.8%) v 9.04%) and the primary (harm) endpoint of fatal, severe, or intracranial bleeding (3.0% (2.0% to 4.4%) v 1.26% (TIMI major bleeding)). Application of intention to treat relative risks from the trial (ticagrelor 60 mg daily arm) to CALIBER’s target population showed an estimated 101 (95% confidence interval 87 to 117) ischaemic events prevented per 10 000 treated per year and an estimated 75 (50 to 110) excess fatal, severe, or intracranial bleeds caused per 10 000 patients treated per year. Generalisation from CALIBER’s target subgroup to all 7238 real world patients who were stable at least one year after acute myocardial infarction showed similar three year risks of ischaemic events (17.2%, 16.0% to 18.5%), with an estimated 92 (86 to 99) events prevented per 10 000 patients treated per year, and similar three year risks of bleeding events (2.3%, 1.8% to 2.9%), with an estimated 58 (45 to 73) events caused per 10 000 patients treated per year.Conclusions This novel use of primary-secondary care linked electronic health records allows characterisation of “healthy trial participant” effects and confirms the potential absolute benefits and harms of dual antiplatelet therapy in representative patients a year or more after acute myocardial infarction.</description><identifier>ISSN: 1756-1833</identifier><identifier>ISSN: 0959-8138</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.i3163</identifier><identifier>PMID: 27334486</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject><![CDATA[Acute coronary syndromes ; Adenosine - administration & dosage ; Adenosine - adverse effects ; Adenosine - analogs & derivatives ; Aged ; Aged, 80 and over ; Angioplasty ; Anticoagulants ; Antiplatelet therapy ; Aspirin ; Aspirin - administration & dosage ; Aspirin - adverse effects ; Bleeding ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - prevention & control ; Cause of Death ; Cerebral infarction ; Clinical trials ; Clinical Trials as Topic ; Codes ; Cohort Studies ; Coronary Disease - drug therapy ; Diabetes ; Drug Therapy, Combination ; Electronic Health Records ; Electronic medical records ; Female ; Heart attacks ; Heart diseases ; Hemorrhage - chemically induced ; Hospitals ; Humans ; Ischemia ; Kidney diseases ; Male ; Middle Aged ; Mortality ; Myocardial infarction ; Myocardial Infarction - prevention & control ; Patient admissions ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Aggregation Inhibitors - adverse effects ; Population studies ; Primary care ; Risk assessment ; Risk Factors ; Secondary Prevention ; Stroke ; Stroke - prevention & control ; Ticagrelor ; Time Factors]]></subject><ispartof>BMJ (Online), 2016-06, Vol.353, p.i3163</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright BMJ Publishing Group LTD Jun 22, 2016</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions 2016 BMJ This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2016 BMJ</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b490t-b0f3939fe8975de305c71eb017210773b8fdd18d08ed829f6006433cb17f207d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/353/bmj.i3163.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/353/bmj.i3163.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,776,780,881,3183,23550,27901,27902,55321,77569,77600,77628,77654</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27334486$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Timmis, A</creatorcontrib><creatorcontrib>Rapsomaniki, E</creatorcontrib><creatorcontrib>Chung, S C</creatorcontrib><creatorcontrib>Pujades-Rodriguez, M</creatorcontrib><creatorcontrib>Moayyeri, A</creatorcontrib><creatorcontrib>Stogiannis, D</creatorcontrib><creatorcontrib>Shah, A D</creatorcontrib><creatorcontrib>Pasea, L</creatorcontrib><creatorcontrib>Denaxas, S</creatorcontrib><creatorcontrib>Emmas, C</creatorcontrib><creatorcontrib>Hemingway, H</creatorcontrib><title>Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><addtitle>BMJ</addtitle><description>Objective To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials.Design Observational population based cohort study.Setting PEGASUS-TIMI-54 trial population and CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).Participants 7238 patients who survived a year or more after acute myocardial infarction.Interventions Prolonged dual antiplatelet therapy after acute myocardial infarction.Main outcome measures Recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease. Fatal, severe, or intracranial bleeding.Results 1676/7238 (23.1%) patients met trial inclusion and exclusion criteria (“target” population). Compared with the placebo arm in the trial population, in the target population the median age was 12 years higher, there were more women (48.6% v 24.3%), and there was a substantially higher cumulative three year risk of both the primary (benefit) trial endpoint of recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease (18.8% (95% confidence interval 16.3% to 21.8%) v 9.04%) and the primary (harm) endpoint of fatal, severe, or intracranial bleeding (3.0% (2.0% to 4.4%) v 1.26% (TIMI major bleeding)). Application of intention to treat relative risks from the trial (ticagrelor 60 mg daily arm) to CALIBER’s target population showed an estimated 101 (95% confidence interval 87 to 117) ischaemic events prevented per 10 000 treated per year and an estimated 75 (50 to 110) excess fatal, severe, or intracranial bleeds caused per 10 000 patients treated per year. Generalisation from CALIBER’s target subgroup to all 7238 real world patients who were stable at least one year after acute myocardial infarction showed similar three year risks of ischaemic events (17.2%, 16.0% to 18.5%), with an estimated 92 (86 to 99) events prevented per 10 000 patients treated per year, and similar three year risks of bleeding events (2.3%, 1.8% to 2.9%), with an estimated 58 (45 to 73) events caused per 10 000 patients treated per year.Conclusions This novel use of primary-secondary care linked electronic health records allows characterisation of “healthy trial participant” effects and confirms the potential absolute benefits and harms of dual antiplatelet therapy in representative patients a year or more after acute myocardial infarction.</description><subject>Acute coronary syndromes</subject><subject>Adenosine - administration & dosage</subject><subject>Adenosine - adverse effects</subject><subject>Adenosine - analogs & derivatives</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angioplasty</subject><subject>Anticoagulants</subject><subject>Antiplatelet therapy</subject><subject>Aspirin</subject><subject>Aspirin - administration & dosage</subject><subject>Aspirin - adverse effects</subject><subject>Bleeding</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Cause of Death</subject><subject>Cerebral infarction</subject><subject>Clinical trials</subject><subject>Clinical Trials as Topic</subject><subject>Codes</subject><subject>Cohort Studies</subject><subject>Coronary Disease - drug therapy</subject><subject>Diabetes</subject><subject>Drug Therapy, Combination</subject><subject>Electronic Health Records</subject><subject>Electronic medical records</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Heart diseases</subject><subject>Hemorrhage - chemically induced</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - prevention & control</subject><subject>Patient admissions</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Population studies</subject><subject>Primary care</subject><subject>Risk assessment</subject><subject>Risk Factors</subject><subject>Secondary Prevention</subject><subject>Stroke</subject><subject>Stroke - prevention & control</subject><subject>Ticagrelor</subject><subject>Time 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A</creator><creator>Rapsomaniki, E</creator><creator>Chung, S C</creator><creator>Pujades-Rodriguez, M</creator><creator>Moayyeri, A</creator><creator>Stogiannis, D</creator><creator>Shah, A D</creator><creator>Pasea, L</creator><creator>Denaxas, S</creator><creator>Emmas, C</creator><creator>Hemingway, H</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>5PM</scope></search><sort><creationdate>20160622</creationdate><title>Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations</title><author>Timmis, A ; Rapsomaniki, E ; Chung, S C ; Pujades-Rodriguez, M ; Moayyeri, A ; Stogiannis, D ; Shah, A D ; Pasea, L ; Denaxas, S ; Emmas, C ; Hemingway, H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b490t-b0f3939fe8975de305c71eb017210773b8fdd18d08ed829f6006433cb17f207d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute coronary syndromes</topic><topic>Adenosine - administration & dosage</topic><topic>Adenosine - adverse effects</topic><topic>Adenosine - analogs & derivatives</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angioplasty</topic><topic>Anticoagulants</topic><topic>Antiplatelet therapy</topic><topic>Aspirin</topic><topic>Aspirin - administration & dosage</topic><topic>Aspirin - adverse effects</topic><topic>Bleeding</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Cause of Death</topic><topic>Cerebral infarction</topic><topic>Clinical trials</topic><topic>Clinical Trials as Topic</topic><topic>Codes</topic><topic>Cohort Studies</topic><topic>Coronary Disease - drug therapy</topic><topic>Diabetes</topic><topic>Drug Therapy, Combination</topic><topic>Electronic Health Records</topic><topic>Electronic medical records</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Heart diseases</topic><topic>Hemorrhage - chemically induced</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - prevention & control</topic><topic>Patient admissions</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Population studies</topic><topic>Primary care</topic><topic>Risk assessment</topic><topic>Risk Factors</topic><topic>Secondary Prevention</topic><topic>Stroke</topic><topic>Stroke - prevention & control</topic><topic>Ticagrelor</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Timmis, A</creatorcontrib><creatorcontrib>Rapsomaniki, E</creatorcontrib><creatorcontrib>Chung, S C</creatorcontrib><creatorcontrib>Pujades-Rodriguez, M</creatorcontrib><creatorcontrib>Moayyeri, A</creatorcontrib><creatorcontrib>Stogiannis, D</creatorcontrib><creatorcontrib>Shah, A D</creatorcontrib><creatorcontrib>Pasea, L</creatorcontrib><creatorcontrib>Denaxas, S</creatorcontrib><creatorcontrib>Emmas, C</creatorcontrib><creatorcontrib>Hemingway, H</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 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China</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Timmis, A</au><au>Rapsomaniki, E</au><au>Chung, S C</au><au>Pujades-Rodriguez, M</au><au>Moayyeri, A</au><au>Stogiannis, D</au><au>Shah, A D</au><au>Pasea, L</au><au>Denaxas, S</au><au>Emmas, C</au><au>Hemingway, H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations</atitle><jtitle>BMJ (Online)</jtitle><stitle>BMJ</stitle><addtitle>BMJ</addtitle><date>2016-06-22</date><risdate>2016</risdate><volume>353</volume><spage>i3163</spage><pages>i3163-</pages><issn>1756-1833</issn><issn>0959-8138</issn><eissn>1756-1833</eissn><abstract>Objective To estimate the potential magnitude in unselected patients of the benefits and harms of prolonged dual antiplatelet therapy after acute myocardial infarction seen in selected patients with high risk characteristics in trials.Design Observational population based cohort study.Setting PEGASUS-TIMI-54 trial population and CALIBER (ClinicAl research using LInked Bespoke studies and Electronic health Records).Participants 7238 patients who survived a year or more after acute myocardial infarction.Interventions Prolonged dual antiplatelet therapy after acute myocardial infarction.Main outcome measures Recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease. Fatal, severe, or intracranial bleeding.Results 1676/7238 (23.1%) patients met trial inclusion and exclusion criteria (“target” population). Compared with the placebo arm in the trial population, in the target population the median age was 12 years higher, there were more women (48.6% v 24.3%), and there was a substantially higher cumulative three year risk of both the primary (benefit) trial endpoint of recurrent acute myocardial infarction, stroke, or fatal cardiovascular disease (18.8% (95% confidence interval 16.3% to 21.8%) v 9.04%) and the primary (harm) endpoint of fatal, severe, or intracranial bleeding (3.0% (2.0% to 4.4%) v 1.26% (TIMI major bleeding)). Application of intention to treat relative risks from the trial (ticagrelor 60 mg daily arm) to CALIBER’s target population showed an estimated 101 (95% confidence interval 87 to 117) ischaemic events prevented per 10 000 treated per year and an estimated 75 (50 to 110) excess fatal, severe, or intracranial bleeds caused per 10 000 patients treated per year. Generalisation from CALIBER’s target subgroup to all 7238 real world patients who were stable at least one year after acute myocardial infarction showed similar three year risks of ischaemic events (17.2%, 16.0% to 18.5%), with an estimated 92 (86 to 99) events prevented per 10 000 patients treated per year, and similar three year risks of bleeding events (2.3%, 1.8% to 2.9%), with an estimated 58 (45 to 73) events caused per 10 000 patients treated per year.Conclusions This novel use of primary-secondary care linked electronic health records allows characterisation of “healthy trial participant” effects and confirms the potential absolute benefits and harms of dual antiplatelet therapy in representative patients a year or more after acute myocardial infarction.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>27334486</pmid><doi>10.1136/bmj.i3163</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1756-1833 |
| ispartof | BMJ (Online), 2016-06, Vol.353, p.i3163 |
| issn | 1756-1833 0959-8138 1756-1833 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4916922 |
| source | Jstor Complete Legacy; MEDLINE; BMJ Journals - NESLi2 |
| subjects | Acute coronary syndromes Adenosine - administration & dosage Adenosine - adverse effects Adenosine - analogs & derivatives Aged Aged, 80 and over Angioplasty Anticoagulants Antiplatelet therapy Aspirin Aspirin - administration & dosage Aspirin - adverse effects Bleeding Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - mortality Cardiovascular Diseases - prevention & control Cause of Death Cerebral infarction Clinical trials Clinical Trials as Topic Codes Cohort Studies Coronary Disease - drug therapy Diabetes Drug Therapy, Combination Electronic Health Records Electronic medical records Female Heart attacks Heart diseases Hemorrhage - chemically induced Hospitals Humans Ischemia Kidney diseases Male Middle Aged Mortality Myocardial infarction Myocardial Infarction - prevention & control Patient admissions Platelet Aggregation Inhibitors - administration & dosage Platelet Aggregation Inhibitors - adverse effects Population studies Primary care Risk assessment Risk Factors Secondary Prevention Stroke Stroke - prevention & control Ticagrelor Time Factors |
| title | Prolonged dual antiplatelet therapy in stable coronary disease: comparative observational study of benefits and harms in unselected versus trial populations |
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