The ADAPTABLE Trial and Aspirin Dosing in Secondary Prevention for Patients with Coronary Artery Disease
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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.
KeywordsAspirin Coronary artery disease Secondary prevention Myocardial infarction
American College of Cardiology Foundation
acute coronary syndrome
American Heart Association
anisoylated plasminogen streptokinase activator complex
Antiplatelet Trialists’ Collaboration
Antithrombotic Trialists’ Collaboration
coronary artery bypass graft
coronary artery disease
clinical data research networks
Global Use of Strategies to Open Occluded Arteries
major adverse cardiovascular event
non-ST-elevation myocardial infarction
Patient Centered Outcomes Research Institute
Practice Innovation and Clinical Excellence
patient-powered research networks
randomized controlled trial
stable ischemic heart disease
ST-elevation myocardial infarction
transient ischemic attack
Thrombolysis in Myocardial Infarction
tissue plasminogen activator
TReatment with ADP receptor iNhibitorS: Longitudinal, Assessment of Treatment Patterns and Events after Acute, Coronary Syndrome
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.
ADAPTABLE is being funded by the Patient-Centered Outcomes Research Institute. Dr. Hernandez serves as the PCORnet Coordinating Center Principal Investigator.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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