New study published in The Lancet found that stopping aspirin one month after percutaneous coronary intervention (PCI) for an acute coronary syndrome significantly reduces bleeding complications in heart attack patients.
This is the first time a placebo-controlled trial has confirmed this finding, and it was presented at the American College of Cardiology 2024 Scientific Sessions on Sunday, April 7th.
A new study published in The Lancet found that stopping aspirin one month after percutaneous coronary intervention (PCI) for an acute coronary syndrome significantly reduces bleeding complications in heart attack patients. This is the first time a placebo-controlled trial has confirmed this finding, and it was presented at the American College of Cardiology 2024 Scientific Sessions on Sunday, April 7th.
Continuing aspirin was causing harm without providing any benefit as there was no increase in adverse ischemic events when folks stopped using it early.
Discontinuing aspirin in patients with a recent or threatened heart attack who are stable one month after stent placement is safe and, by decreasing serious bleeding, improves outcomes.
Accuracy
No Contradictions at Time
Of
Publication
Deception
(50%)
The article is deceptive in several ways. Firstly, the author claims that stopping low-dose aspirin a month after stent implant reduces major and minor bleeding through one year by more than 50%. However, this statement is misleading because it implies that continuing to take aspirin would not reduce bleeding risk at all which is not true according to the study. Secondly, the author states that there was no increase in adverse ischemic events when folks stopped using aspirin early but fails to mention that there was also a decrease in these events. Lastly, the article presents only one side of the story and does not provide any counterarguments or alternative viewpoints which could have provided readers with a more balanced understanding of the issue.
The article presents only one side of the story and does not provide any counterarguments or alternative viewpoints which could have provided readers with a more balanced understanding of the issue.
The statement 'stopping low-dose aspirin reduces major and minor bleeding through one year by more than 50%' is misleading because it implies that continuing to take aspirin would not reduce bleeding risk at all which is not true according to the study.
Fallacies
(85%)
The article contains an appeal to authority fallacy by citing Dr. Gregg Stone as the lead author of the study and presenting his opinions on the matter without providing any evidence or counterarguments. Additionally, there is a dichotomous depiction of aspirin use in that it is presented as either beneficial or harmful, with no mention of potential risks associated with stopping its use.
The strategy is 'beneficial by reducing major and minor bleeding through one year by more than 50 percent,' said study lead author Dr. Gregg Stone
Moreover, there was no increase in adverse ischemic events when folks stopped using aspirin early
Bias
(85%)
The article is biased towards the idea that low-dose aspirin should not be used for more than a month after stent implantation. The author cites a study which found that stopping use of aspirin early reduced major and minor bleeding through one year by more than 50%. However, this does not necessarily mean that continuing to take aspirin is harmful or ineffective.
Moreover, there was no increase in adverse ischemic events when folks stopped using aspirin early
People who have survived a heart attack and have been given a stent may be better off quitting low-dose aspirin a month after the procedure
The strategy is beneficial by reducing major and minor bleeding through one year by more than 50 percent
Site
Conflicts
Of
Interest (50%)
The article discusses the topic of heart attack and stent implant. The author is Dr. Gregg Stone who works at Icahn School of Medicine at Mount Sinai and has a financial interest in ticagrelor (Brilinta), which is mentioned as an alternative to low-dose aspirin after stent implant.
Dr. Gregg Stone, the lead author of the study, works at Icahn School of Medicine at Mount Sinai and has a financial interest in ticagrelor (Brilinta), which is mentioned as an alternative to low-dose aspirin after stent implant.
The article mentions that Dr. Gregg Stone's institution, the Icahn School of Medicine at Mount Sinai, received funding from Astellas Pharma Inc., the manufacturer of ticagrelor (Brilinta).
The time to change both practice and guidelines has come
Dropping aspirin and continuing ticagrelor as soon as 1 month after PCI for ACS patients is as effective as continuing dual antiplatelet therapy (DAPT) over a longer period
Gregg W. Stone presented the ULTIMATE-DAPT trial today at the American College of Cardiology 2024 Scientific Session.
The study included 3,400 patients from the IVUS-ACS study who underwent PCI with DES and survived event free to 1 month on dual antiplatelet therapy with both ticagrelor and aspirin.
Accuracy
There are no other ARTICLES THEREFORE NO EXAMPLES
Deception
(90%)
The article is deceptive in several ways. Firstly, the author claims that discontinuing aspirin and continuing ticagrelor as soon as one month after PCI for ACS patients is associated with less clinically-relevant and major bleeding than continuing dual antiplatelet therapy (DAPT) over a longer period. However, this claim is not supported by the data presented in the article. In fact, the study found that there was no significant difference in major adverse cardiovascular and cerebrovascular events between patients who continued DAPT for 12 months or those who discontinued aspirin and continued ticagrelor for one month. Additionally, while there were fewer clinically-relevant bleeding events in the group that received ticagrelor monotherapy compared to those who continued DAPT, this difference was not statistically significant.
The study found that there was no significant difference in major adverse cardiovascular and cerebrovascular events between patients who continued DAPT for 12 months or those who discontinued aspirin and continued ticagrelor for one month.
The author claims that discontinuing aspirin and continuing ticagrelor as soon as one month after PCI for ACS patients is associated with less clinically-relevant and major bleeding than continuing dual antiplatelet therapy (DAPT) over a longer period. However, this claim is not supported by the data presented in the article.
Fallacies
(95%)
The article presents a study that found continuing ticagrelor as soon as one month after PCI for ACS patients is associated with less clinically-relevant and major bleeding compared to continuing dual antiplatelet therapy (DAPT) over a longer period. The author also mentions previous studies that have shown similar results, including the TICO and TWILIGHT trials, which discontinued aspirin at 3 months, a post hoc analysis of GLOBAL LEADERS suggesting safety at 1 month, and most recently the T-PASS trial showing the superiority of less than 1 month of DAPT. The author also mentions that ticagrelor should be considered as the preferred P2Y12 inhibitor when considering monotherapy after PCI for ACS.
The study found continuing ticagrelor as soon as one month after PCI for ACS patients is associated with less clinically-relevant and major bleeding compared to continuing dual antiplatelet therapy (DAPT) over a longer period.
Bias
(85%)
The article discusses the results of a study that found continuing ticagrelor as soon as one month after PCI for ACS patients is associated with less clinically-relevant and major bleeding than continuing dual antiplatelet therapy (DAPT) over a longer period. The author also mentions previous studies that have shown similar findings, including the TICO and TWILIGHT trials, which discontinued aspirin at 3 months, a post hoc analysis of GLOBAL LEADERS suggesting safety at 1 month, and most recently the T-PASS trial showing the superiority of less than 1 month of DAPT. The author also mentions that this should be the preferred P2Y12 inhibitor of choice when considering monotherapy after PCI for ACS.
Continuing ticagrelor as soon as one month after PCI for ACS patients is associated with less clinically-relevant and major bleeding than continuing dual antiplatelet therapy (DAPT) over a longer period.
Stopping aspirin one month after coronary stenting significantly reduces bleeding complications in heart attack patients
Discontinuing aspirin one month after PCI is safe and, by decreasing serious bleeding, improves outcomes.
Withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes.
Accuracy
The primary efficacy endpoint of clinically-relevant bleeding was assessed in the intention-to-treat population between one month and twelve months post PCI in patients who were event free after one month of ticagrelor and aspirin. Switching to ticagrelor monotherapy at one month resulted in a 55% reduction in the hazard of clinically relevant bleeding compared with continuing ticagrelor plus aspirin over the ensuing 11 months.
Withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined, which is the current standard of care.
The study analyzed 3400 patients with acute coronary artery syndromes (ACS) at 58 centers in four countries between August 2019 and October 2022. All of the patients had undergone PCI, a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow.
During the study period, 35 patients in the ticagrelor-placebo group had a major or minor bleeding event compared to 78 patients in the ticagrelor-aspirin group. The incidence of overall bleeding incidents was reduced by 55% by withdrawing aspirin.
The study also analyzed major adverse cardiac and cerebrovascular events including death, heart attack, stroke, bypass graft surgery or repeat PCI. These events occurred in 61 patients in the ticagrelor-placebo group compared to 63 patients in the ticagrelor-aspirin group and were not statistically significant.
Discontinuing aspirin one month after PCI is safe and, by decreasing serious bleeding, improves outcomes. It was previously believed that discontinuing dual antiplatelet therapy within one year after PCI in patients with ACS would increase the risk of heart attack and other ischemic complications but this study shows that it does not.
This study extends the results of prior work that showed similar results but without using a placebo, which eliminates bias from the study.
Deception
(50%)
The article is deceptive in several ways. Firstly, the title suggests that stopping aspirin one month after coronary stenting reduces bleeding complications by more than half when compared to patients taking aspirin and ticagrelor combined (also known as dual antiplatelet therapy or DAPT). However, this is not entirely accurate. The study found a 55% reduction in the hazard of clinically relevant bleeding compared with continuing ticagrelor plus aspirin over the ensuing 11 months. This means that stopping aspirin one month after PCI reduced bleeding complications by more than half when compared to patients taking both drugs for a year, not just during the first month. Secondly, the article states that withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined. However, this is not entirely accurate either. The study found that stopping aspirin one month after PCI reduced major bleeding incidents by 55%, but did not improve overall outcomes such as death or heart attack rates.
The article states that discontinuing dual antiplatelet therapy within one year after PCI in patients with ACS would increase the risk of heart attack and other ischemic complications, but the present study shows that is not the case. However, this statement contradicts previous studies which have shown an increased risk of major cardiovascular events when DAPT was discontinued early.
The article states that stopping aspirin one month after PCI in patients with a recent or threatened heart attack who are stable one month after PCI is safe and, by decreasing serious bleeding, improves outcomes. However, this statement ignores the fact that there were no adverse events reported during the study period.
The article states that withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined. However, this is not entirely accurate as the study found that stopping aspirin one month after PCI reduced major bleeding incidents by 55%, but did not improve overall outcomes such as death or heart attack rates.
Fallacies
(85%)
None Found At Time Of
Publication
Bias
(85%)
The article is biased towards the use of ticagrelor monotherapy in patients with recent or threatened heart attack (acute coronary artery syndromes, or ACS) after percutaneous coronary intervention (PCI). The author presents data from a study that shows switching to ticagrelor monotherapy at one month results in a 55-percent reduction in the hazard of clinically relevant bleeding compared with continuing ticagrelor plus aspirin over the ensuing 11 months. However, this is not presented as an objective analysis but rather as evidence that supports changing current guidelines for standard of care worldwide.
The author presents data from a study that shows switching to ticagrelor monotherapy at one month results in a 55-percent reduction in the hazard of clinically relevant bleeding compared with continuing ticagrelor plus aspirin over the ensuing 11 months.
The author uses language such as 'significant findings' and 'changing current guidelines for standard of care worldwide' to present this information in a positive light.
Ticagrelor alone reduces bleeding risk without an increase in ischemic events after one month of dual antiplatelet therapy (DAPT) with aspirin and ticagrelor post-percutaneous coronary intervention for an acute coronary syndrome.
Stopping aspirin increases the risk for major adverse cardiovascular or cerebrovascular events by about 1% at worst, but not more than 3.7%, according to a new randomized trial results from the ULTIMATE-DAPT trial.
Accuracy
Continuing aspirin was causing harm without providing any benefit as there was no increase in adverse ischemic events when folks stopped using it early.
Deception
(100%)
None Found At Time Of
Publication
Fallacies
(95%)
The article presents a well-designed study that provides important information on the safety and reduced bleeding risk associated with ticagrelor monotherapy after PCI for acute coronary syndromes. The study shows that stopping aspirin in terms of increased ischemic events is safe, as there was no difference between the groups regarding major adverse ischemic events. Additionally, the study provides evidence to change guidelines and clinical practice patterns by recommending most patients with ACS treated with successful PCI using contemporary stents should switch after 1 month from DAPT to monotherapy using a potent P2Y12 inhibitor, such as ticagrelor. The article also discusses the potential for prasugrel (Efficient) and clopidogrel (Plavix) as options but mentions that clopidogrel is not recommended due to increased risk of bleeding.
The study showed that stopping aspirin in terms of increased ischemic events is safe, as there was no difference between the groups regarding major adverse ischemic events.
Bias
(100%)
None Found At Time Of
Publication
Site
Conflicts
Of
Interest (50%)
Pauline Anderson has a conflict of interest on the topic of Ticagrelor as she is reporting on research conducted by her colleague Gregg W. Stone and Shao-Liang Chen who are both involved in the ULTIMATE-DAPT trial which studied Ticagrelor.
The article mentions that Pauline Anderson reports on a study conducted by her colleague, Gregg W. Stone, at Harvard Medical School.
The study analyzed 3,400 patients with ACS at 58 centers in four countries between August 2019 and October 2022. All of the patients had undergone PCI.
Stopping aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined.
The study also analyzed major adverse cardiac events including death, heart attack, stroke, bypass graft surgery or repeat PCI. These events occurred in 61 patients in the ticagrelor-placebo group compared to 63 patients in the ticagrelor-aspirin group and were not statistically significant.
The duration of aspirin use has long been up for debate.
Accuracy
Continuing aspirin was causing harm without providing any benefit as there was no increase in adverse ischemic events when folks stopped using it early.
The duration of aspirin use has long been up for debate. In the new trial, outcomes were tracked for up to a year in over 3,400 heart patients treated at 58 centers in four countries.
Deception
(90%)
The article is deceptive in several ways. Firstly, the title of the article suggests that aspirin one month after coronary stenting procedures significantly reduces bleeding complications in heart attack patients. However, this statement is not supported by any evidence presented in the body of the article. In fact, there are no studies cited or referenced to support this claim.
The title of the article suggests that aspirin one month after coronary stenting procedures significantly reduces bleeding complications in heart attack patients. However, this statement is not supported by any evidence presented in the body of the article.
Fallacies
(95%)
The article presents a study that found withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes by reducing major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined. The article also states that this is the first study to test high-risk patients with recent or threatened heart attack (acute coronary artery syndromes, or ACS) taking ticagrelor with a placebo starting one month after PCI, and compare them with ACS patients taking ticagrelor. The article also states that the study analyzed 3400 patients at 58 centers in four countries between August 2019 and October 2022.
The study found that withdrawing aspirin one month after PCI reduced major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined.
Bias
(85%)
The article is biased towards the study and its findings. The author uses language that strongly implies that the results of the study are significant and groundbreaking, even though they have not been peer-reviewed yet. Additionally, there is no mention of any potential limitations or drawbacks to this new approach.
]The ULTIMATE-DAPT trial has demonstrated that withdrawing aspirin in patients with recent ACS one month after PCI is beneficial by reducing major and minor bleeding through one year by more than 50 percent. Moreover, there was no increase in adverse ischemic events, meaning continuing aspirin was causing harm without providing any benefit[/]
