Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease
Authors' conclusion
A large proportion of contemporary CVD patients would be eligible for intensified antithrombotic treatment trials, with mostly similar adjusted event risks to ineligible patients.
Study context
- Population
- Coronary artery disease (CAD) and/or peripheral artery disease (PAD) patients from UCC-SMART
- Exposure
- Trial-eligible vs trial-ineligible real-world patients
- Outcome
- Real-world eligibility for antithrombotic treatment intensification trials
Main finding
As reported in the abstract
Eligibility
Eligibility, CAD
11%-94%
Eligibility, PAD
75%-90%
Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | |
|---|---|---|
| CV events, eligible vs ineligibleEligible vs Ineligible · COMPASS, CAD | 1.98 (1.74–2.26) | |
| CV events, eligible vs ineligibleEligible vs Ineligible · CHARISMA | 1.51 (1.12–2.06) | |
| CV events, eligible vs ineligibleEligible vs Ineligible · COMPASS, PAD | 0.45 (0.36–0.56) | |
| CV events, eligible vs ineligibleEligible vs Ineligible · DAPT, CAD | 0.49 (0.34–0.69) | |
| Mortality, eligible vs ineligibleEligible vs Ineligible · COMPASS, CAD | 3.11 (2.71–3.57) | |
| Mortality, eligible vs ineligibleEligible vs Ineligible · CHARISMA | 4.43 (2.79–7.51) | |
| Mortality, eligible vs ineligibleEligible vs Ineligible · COMPASS, PAD | 0.45 (0.38–0.54) | |
| Mortality, eligible vs ineligibleEligible vs Ineligible · DAPT, CAD | 0.67 (0.48–0.94) | |
| 0.10.31310Relative risk (log scale) |
Adjusted for trial eligibility criteria
- Only higher CV and mortality risks in COMPASS-eligible CAD and lower CV risks in Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA)-eligible and Dual Antiplatelet Therapy (DAPT)-eligible CAD persisted
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Major bleeding, eligible vs ineligibleEligible vs Ineligible · COMPASS, CAD | 2.02 (1.47–2.78) | |
| Major bleeding, eligible vs ineligibleEligible vs Ineligible · CHARISMA | 2.25 (1.01–6.21) | |
| Major bleeding, eligible vs ineligibleEligible vs Ineligible · COMPASS, PAD | 0.29 (0.18–0.46) | |
| 0.10.31310Relative risk (log scale) |
Original publication
Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease. Heart. Published 5 January 2024. doi:10.
Summarised from the published abstract; every number is checked against it