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The ADAPTABLE Trial and Aspirin Dosing in Secondary Prevention for Patients with Coronary Artery Disease

  • Abigail Johnston
  • W. Schuyler Jones
  • Adrian F. Hernandez
New Therapies for Cardiovascular Disease (KW Mahaffey, Section Editor)
Part of the following topical collections:
  1. Topical Collection on New Therapies for Cardiovascular Disease

Abstract

Coronary artery disease (CAD) is the underlying cause of death in one out of seven deaths in the USA. Aspirin therapy has been proven to decrease mortality and major adverse cardiovascular events in patients with CAD. Despite a plethora of studies showing the benefit of aspirin in secondary prevention of cardiovascular events, debate remains regarding the optimal dose due to relatively small studies that had disparate results when comparing patients taking different aspirin dosages. More recently, aspirin dosing has been thoroughly studied in the CAD population with concomitant therapy (such as P2Y12 inhibitors); however, patients in these studies were not randomized to aspirin dose. No randomized controlled trial has directly measured aspirin dosages in a population of patients with established coronary artery disease. In 2015, the Patient-Centered Outcomes Research Institute (PCORI) developed a network, called PCORnet, that includes patient-powered research networks (PPRN) and clinical data research networks (CDRN). The main objective of PCORnet is to conduct widely generalizable observational studies and clinical trials (including large, pragmatic clinical trials) at a low cost. The first clinical trial, called Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE), will randomly assign 20,000 subjects with established coronary heart disease to either low dose (81 mg) or high dose (325 mg) and should be able to finally answer which dosage of aspirin is best for patients with established cardiovascular disease.

Keywords

Aspirin Coronary artery disease Secondary prevention Myocardial infarction 

Abbreviations

ACCF

American College of Cardiology Foundation

ACS

acute coronary syndrome

AHA

American Heart Association

APSAC

anisoylated plasminogen streptokinase activator complex

ATC

Antiplatelet Trialists’ Collaboration

ATT

Antithrombotic Trialists’ Collaboration

CABG

coronary artery bypass graft

CAD

coronary artery disease

CDRN

clinical data research networks

COX

cyclooxygenase

CVD

cardiovascular disease

DAPT

dual-antiplatelet therapy

GUSTO

Global Use of Strategies to Open Occluded Arteries

MACE

major adverse cardiovascular event

MI

myocardial infarction

NSTEMI

non-ST-elevation myocardial infarction

PCORI

Patient Centered Outcomes Research Institute

PINNACLE

Practice Innovation and Clinical Excellence

PPRNs

patient-powered research networks

RCT

randomized controlled trial

SIHD

stable ischemic heart disease

STEMI

ST-elevation myocardial infarction

TIA

transient ischemic attack

TIMI

Thrombolysis in Myocardial Infarction

tPA

tissue plasminogen activator

TRANSLATE-ACS

TReatment with ADP receptor iNhibitorS: Longitudinal, Assessment of Treatment Patterns and Events after Acute, Coronary Syndrome

UA

unstable angina

Notes

Compliance with Ethics Standards

Conflict of Interest

Abigail Johnston declares that she has no conflict of interest.

W. Schuyler Jones reports research grants from Agency for Healthcare Research and Quality, AstraZeneca, American Heart Association, Boston Scientific Corporation, Bristol-Myers Squibb, and Patient-Centered Outcomes Research Institute; and honorarium/other from American College of Radiology and Daiichi Sankyo.

Adrian F. Hernandez reports research grants from Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Glaxo SmithKline, Merck, and Portola Pharmaceuticals; and consulting from Amgen, AstraZeneca, Bayer, Eli Lilly, Gilead, Glaxo SmithKline, Janssen, Merck, Novartis, Ortho-McNeil, Pfizer, Pluristem Therapeutics, and MyoKardia.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Funding/Support

ADAPTABLE is being funded by the Patient-Centered Outcomes Research Institute. Dr. Hernandez serves as the PCORnet Coordinating Center Principal Investigator.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Abigail Johnston
    • 1
    • 2
  • W. Schuyler Jones
    • 1
    • 2
  • Adrian F. Hernandez
    • 1
    • 2
  1. 1.Duke Clinical Research InstituteDuke University School of MedicineDurhamUSA
  2. 2.Department of MedicineDuke University School of MedicineDurhamUSA

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