Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation

作者：Gilles Lemesle, Romain Didier, Philippe Gabríel Steg, Tabassome Simon, Gilles Montalescot, Nicolas Danchin, Christophe Bauters, Didier Blanchard, Claire Bouleti, Denis Angoulvant, Stéphane Andrieu, Gérald Vanzetto, Mathieu Kernéis, Véronique Decalf, Étienne Puymirat, Dominique Mottier, Abdourahmane Diallo, Éric Vicaut, Martine Gilard, Guillaume Cayla · 发表于：New England Journal of Medicine · 年份：2025 · DOI：10.1056/nejmoa2507532 · 被引用次数：61 · 研究领域：Atrial Fibrillation Management and Outcomes、Antiplatelet Therapy and Cardiovascular Diseases、Acute Myocardial Infarction Research

BACKGROUND: The appropriate antithrombotic regimen for patients with chronic coronary syndrome who are at high atherothrombotic risk and receiving long-term oral anticoagulation remains unknown. METHODS: We conducted a multicenter, double-blind, randomized, placebo-controlled trial in France involving patients with chronic coronary syndrome who had undergone a previous stent implantation (>6 months before enrollment) and were at high atherothrombotic risk and currently receiving long-term oral anticoagulation. The patients were randomly assigned in a 1:1 ratio to receive aspirin (100 mg once daily) or placebo; all the patients continued to receive their current oral anticoagulation therapy. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, stroke, systemic embolism, coronary revascularization, or acute limb ischemia. The key safety outcome was major bleeding. RESULTS: A total of 872 patients underwent randomization; 433 were assigned to the aspirin group, and 439 to the placebo group. The trial was stopped early at the advice of the independent data and safety monitoring board after a median follow-up of 2.2 years because of an excess of deaths from any cause in the aspirin group. A primary efficacy outcome event occurred in 73 patients (16.9%) in the aspirin group and in 53 patients (12.1%) in the placebo group (adjusted hazard ratio, 1.53; 95% confidence interval [CI], 1.07 to 2.18; P = 0.02). Death from any cause occurred in 58 pa...