■我们的目的是了解阿司匹林剂量对外周动脉疾病(PAD)患者预后的影响,以及他们参与一项务实的随机对照试验。
■在对阿司匹林剂量的亚分析中:以患者为中心的评估益处和长期有效性的试验(适应)研究,我们比较了PAD患者的阿司匹林剂量(81mgvs325mg),以及PAD患者和无PAD患者的研究参与指标.主要结果复合是全因死亡率,非致死性心肌梗死,和非致命性中风.
■在14,662名注册为ADAPTABLE并具有PAD状态的参与者中,3493(23.8%)患有PAD。患有PAD的参与者更有可能经历主要复合物(13.76%vs5.31%,p<0.001),全因死亡率(7.55%vs3.01%,p<0.001),心肌梗死(5.71%vs2.09%,p<0.001),中风(2.45%vs0.86%,p<0.001),和大出血(1.19%vs0.44%,p<0.001)。较高的阿司匹林剂量并未降低PAD患者的主要结局(81mg和325mg组的13.68%vs13.84%;OR1.05,95%CI0.88-1.25)。PAD参与者不太可能通过电子邮件注册(33.0%vs41.9%,p<0.0001),选择互联网随访的可能性较小(79.2%对89.5%,p<0.0001),并且更有可能改变他们的阿司匹林剂量(39.7%vs30.7%,p<0.0001)。
■ADAPTABLE患有PAD的参与者没有从较高剂量的阿司匹林中受益,并且与没有PAD的参与者不同。这些结果加强了对额外的PAD特异性研究的需求,并表明可能需要不同的试验策略来优化PAD患者的参与。(ClinicalTrials.gov标识符:NCT02697916)。
We aimed to understand the effects of aspirin dose on outcomes in patients with peripheral artery disease (PAD) as well as their participation in a pragmatic randomized controlled trial.
In a subanalysis of the Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness (ADAPTABLE) study, we compared aspirin doses (81 vs 325 mg) among participants with PAD and study participation metrics in patients with and without PAD. The primary outcome composite was all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke.
Among 14,662 participants enrolled in ADAPTABLE with PAD status available, 3493 (23.8%) had PAD. Participants with PAD were more likely to experience the primary composite (13.76% vs 5.31%, p < 0.001), all-cause mortality (7.55% vs 3.01%, p < 0.001), myocardial infarction (5.71% vs 2.09%, p < 0.001), stroke (2.45% vs 0.86%, p < 0.001), and major bleeding (1.19% vs 0.44%, p < 0.001). A higher aspirin dose did not reduce the primary outcome in patients with PAD (13.68% vs 13.84% in 81 mg and 325 mg groups; OR 1.05, 95% CI 0.88-1.25). Participants with PAD were less likely to enroll via email (33.0% vs 41.9%, p < 0.0001), less likely to choose internet follow-up (79.2% vs 89.5%, p < 0.0001), and were more likely to change their aspirin doses (39.7% vs 30.7%, p < 0.0001).
ADAPTABLE participants with PAD did not benefit from a higher dose of aspirin and participated in the study differently from those without PAD. These results reinforce the need for additional PAD-specific research and suggest that different trial strategies may be needed for optimal engagement of patients with PAD. (ClinicalTrials.gov Identifier: NCT02697916).