{"id":"e55f57466779","type":"article","url":"https://hartvaat.nl/2017/10/19/dubbele-antitrombotische-therapie-met-dabigatran-na-pci-bij-af-nejm-re-dual-pci/","title":"Dubbele antitrombotische therapie met dabigatran na PCI bij AF: NEJM RE-DUAL PCI","title_en":"Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1708454","source_url":"https://doi.org/10.1056/NEJMoa1708454","authors":["Christopher P Cannon","Deepak L Bhatt","Jonas Oldgren","Gregory Y H Lip","Stephen G Ellis","Takeshi Kimura","Michael Maeng","Bela Merkely","Uwe Zeymer","Savion Gropper","Matias Nordaby","Eva Kleine","Ruth Harper","Jenny Manassie","James L Januzzi","Jurrien M Ten Berg","P Gabriel Steg","Stefan H Hohnloser"],"significance":10,"published":"2017-10-19","source_date":"2017-10-19","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The RE-DUAL PCI trial showed that dual antithrombotic therapy with dabigatran plus a P2Y12 inhibitor (without aspirin) significantly reduced bleeding compared with triple therapy in patients with atrial fibrillation who underwent PCI. Together with PIONEER AF-PCI, this trial established the paradigm shift toward dropping aspirin in this population.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM RE-DUAL PCI-trial die dubbele antitrombotische therapie (dabigatran + P2Y12) vergeleek met triple therapie bij AF-patiënten na PCI. Samen met PIONEER AF-PCI bepalend voor het nieuwe paradigma.","abstract_original":"BACKGROUND: Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding. METHODS: In this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups). Outside the United States, elderly patients (≥80 years of age; ≥70 years of age in Japan) were randomly assigned to the 110-mg dual-therapy group or the triple-therapy group. The primary end point was a major or clinically relevant nonmajor bleeding event during follow-up (mean follow-up, 14 months). The trial also tested for the noninferiority of dual therapy with dabigatran (both doses combined) to triple therapy with warfarin with respect to the incidence of a composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization. RESULTS: The incidence of the primary end point was 15.4% in the 110-mg dual-therapy group as compared with 26.9% in the triple-therapy group (hazard ratio, 0.52; 95% confidence interval [CI], 0.42 to 0.63; P<0.001 for noninferiority; P<0.001 for superiority) and 20.2% in the 150-mg dual-therapy group as compared with 25.7% in the corresponding triple-therapy group, which did not include elderly patients outside the United States (hazard ratio, 0.72; 95% CI, 0.58 to 0.88; P<0.001 for noninferiority). The incidence of the composite efficacy end point was 13.7% in the two dual-therapy groups combined as compared with 13.4% in the triple-therapy group (hazard ratio, 1.04; 95% CI, 0.84 to 1.29; P=0.005 for noninferiority). The rate of serious adverse events did not differ significantly among the groups. CONCLUSIONS: Among patients with atrial fibrillation who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with dabigatran and a P2Y12 inhibitor than among those who received triple therapy with warfarin, a P2Y12 inhibitor, and aspirin. Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events. (Funded by Boehringer Ingelheim; RE-DUAL PCI ClinicalTrials.gov number, NCT02164864 .)."}