Abstract
[first paragraph of article] Potent and consistent P2Y12 receptor inhibition is associated with reduced risk of atherothrombotic events in patients presenting with acute coronary syndromes (ACS), but with inevitable increased risk of bleeding as demonstrated in TRITON and PLATO trials – a finding that is especially pertinent to the treatment of medically managed NSTE ACS patients, who typical have a greater burden of comorbidities that predispose to bleeding. Given the significant proportion of non-ST elevation myocardial infarction (NSTE) ACS patients managed medically worldwide and the need to mitigate both ischemic and bleeding risks in this vulnerable, high-risk population, novel clinical trials are needed.
Highlights
Potent and consistent P2Y12 receptor inhibition is associated with reduced risk of atherothrombotic events in patients presenting with acute coronary syndromes (ACS), but with inevitable increased risk of bleeding as demonstrated in TRITON1 and PLATO2 trials – a finding that is especially pertinent to the treatment of medically managed non-ST elevation myocardial infarction (NSTE) ACS patients, who typical have a greater burden of comorbidities that predispose to bleeding
TRILOGY ACS is randomized, double-blind, double-dummy, active control, event-driven trial, that was conducted to evaluate whether aspirin plus prasugrel is superior to aspirin plus clopidogrel for long-term therapy in patients with unstable angina (UA) or NSTEMI who are treated medically without revascularization
The difference in treatment effect between the first 12 months and subsequent months was tested in a post hoc analysis using a time-dependent Cox proportional-hazards model; in this analysis, the time period and the interaction between the time period and treatment were time dependent factors
Summary
TRILOGY ACS is randomized, double-blind, double-dummy, active control, event-driven trial, that was conducted to evaluate whether aspirin plus prasugrel is superior to aspirin plus clopidogrel for long-term therapy in patients with unstable angina (UA) or NSTEMI who are treated medically without revascularization. RESULTS Regarding efficacy; at 30 months, there was no significant between group difference in the rate of the primary end point
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