{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:42:40Z","timestamp":1790102560815,"version":"4.0.1"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Balancing ischemic and bleeding risk is an evolving framework.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>Our objectives were to simulate changes in risks for adverse events and event-driven costs with use of ticagrelor or prasugrel versus clopidogrel according to varying levels of ischemic and bleeding risk. Using the validated PARIS risk functions, we estimated 1-year ischemic (myocardial infarction or stent thrombosis) and bleeding (Bleeding Academic Research Consortium types 3 or 5) event rates among PARIS study participants who underwent percutaneous coronary intervention with drug-eluting stent implantation for an acute coronary syndrome and were discharged with aspirin and clopidogrel (n=1497). Simulated changes in adverse events with ticagrelor or prasugrel were calculated by applying treatment effects from randomized trials for a 1-year time horizon. Event costs were estimated using National Inpatient Sample data. Net costs were calculated between antiplatelet therapy groups according to level of ischemic and bleeding risk. After weighting events for quality-of-life impact, we calculated event rates and costs for risk-tailored treatment versus clopidogrel under multiple drug pricing assumptions. One-year rates (per 1000 person-years) for ischemic events were 12.6, 24.1, and 66.1, respectively, among those at low (n=630), intermediate (n=536), and high (n=331) ischemic risk. Analogous bleeding rates were 11.0, 23.9, and 66.2, respectively, among low (n=728), intermediate (n=634), and high (n=135) bleeding risk patients. Mean per event costs were $22\u2009174 (ischemic) and $12\u2009203 (bleeding). When risks for ischemia matched or exceeded bleeding, simulated utility-weighted event rates favored ticagrelor\/prasugrel, whereas clopidogrel reduced utility-weighted events when bleeding exceeded ischemic risk. One-year costs were sensitive to drug pricing assumptions, and risk-tailored treatment with either agent progressed from cost incurring to cost saving with increasing generic market share.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Tailoring antiplatelet therapy intensity to patient risk may improve health utility and could produce cost savings in the first year after percutaneous coronary intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00998127.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.118.004945","type":"journal-article","created":{"date-parts":[[2019,1,4]],"date-time":"2019-01-04T10:00:32Z","timestamp":1546596032000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Tailoring Antiplatelet Therapy Intensity to Ischemic and Bleeding Risk"],"prefix":"10.1161","volume":"12","author":[{"given":"Usman","family":"Baber","sequence":"first","affiliation":[{"name":"Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Leisman","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Saint Luke\u2019s Mid America Heart Institute, University of Missouri\u2013Kansas City (D.J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Michael","family":"Gibson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Henry","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (T.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Dangas","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Moliterno","sequence":"additional","affiliation":[{"name":"Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington KY (D.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annapoorna","family":"Kini","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Krucoff","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (M.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Colombo","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A. Colombo, A. Chieffo)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaide","family":"Chieffo","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A. Colombo, A. Chieffo)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Sartori","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Witzenbichler","sequence":"additional","affiliation":[{"name":"Helios Amper-Klinikum, Dachau, Germany (B.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe Gabriel","family":"Steg","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Diderot, Sorbonne Paris-Cit\u00e9, France (P.G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart J.","family":"Pocock","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine, United Kingdom (S.J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Mehran","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (U.B., D.E.L., G.D., A.K., S.S., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.07.013"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22341"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"e_1_3_3_6_2","first-page":"e123","article-title":"Duration of dual antiplatelet therapy: a systematic review for the 2016 ACC\/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"134","author":"Bittl JA","year":"2016","unstructured":"Bittl, JA, Baber, U, Bradley, SM, Wijeysundera, DN. 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