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Resident Evil: The Final Chapter is a science fiction action film written and directed by Paul W. S. Anderson. A direct sequel to Resident Evil: Retribution.
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In perspective, we should acknowledge that most trials of new antithrombotic compounds across disparate clinical scenarios were performed on a background of aspirin therapy. This occurred in the large CAPRIE trial, published in and including 19, patients with recent stroke, recent MI or symptomatic peripheral artery disease, where clopidogrel decreased the composite of death, MI or stroke and was associated with less gastrointestinal bleeding compared with aspirin 8.

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In the earlier TASS trial, published in and including 3, patients at increased risk of stroke, ticlopidine was also found to decrease the composite of death or stroke, and had less gastrointestinal bleeding compared with aspirin at a higher dose than normally accepted today 1, mg 9. SOCRATES, a more contemporary trial of ticagrelor versus a low dose of aspirin in 13, patients with acute stroke or transient ischaemic attack, found no difference in death, MI and stroke or in bleeding, but ticagrelor reduced stroke, an important secondary endpoint Starting from , a new series of studies is now investigating aspirin-free strategies in the field of PCI 5.

It is no surprise that the first trials where this strategy was attempted included orally anticoagulated patients, who are HBR by definition 2. The question now becomes whether renouncing aspirin early i. Indeed, we already know that low-risk patients who receive contemporary stent technologies do not need prolonged DAPT to avoid stent thrombosis, but is dropping aspirin the same as dropping a P2Y 12 inhibitor?

One argument that is reasonably raised by advocates of maintaining aspirin in preference to clopidogrel is that P2Y 12 inhibitors are not immune from a certain degree of interindividual variability in platelet inhibition Therefore, keeping patients on chronic clopidogrel only could expose those who are clopidogrel-resistant to the risk of not being protected at all. The abovementioned CAPRIE trial partly addresses these concerns, suggesting that the larger proportions of high on-treatment platelet resistance noted in pharmacodynamic studies of clopidogrel did not translate into significant incremental risk on the ground of a large-scale clinical evaluation 8.

If anything, this variability could be addressed by the use of other P2Y 12 inhibitors, such as prasugrel or ticagrelor. Figure 1. Study design of trials of short dual antiplatelet therapy following percutaneous coronary intervention. Studies of short DAPT with aspirin discontinuation have produced controversial results so far Table 1.


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With a p-value of 0. Recently, two Asian studies of short DAPT and aspirin-free strategies were published, with more positive findings 14 Both trials were designed to assess non-inferiority and met their primary objective. Limitations of small non-inferiority trials of short DAPT also apply to these cases, and the external validity of the study findings should be considered in the context of the low-risk populations included and the wide use of intracoronary imaging to optimise the results of PCI.

Designed as an exploratory trial, ASET will be interrupted according to pre-specified stopping rules if more than three stent thromboses occur during recruitment. References 1.

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J Am Coll Cardiol ; 2. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J ;:- 3. Eur Heart J ;39 3 4. Lancet ; 5. Aspirin-free strategies in cardiovascular disease and cardioembolic stroke prevention. Nat Rev Cardiol ; 6. J Am Coll Cardiol ; 7.

Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. Lancet ; 8. Jane asked her husband to take their kids out for a nice dinner with any money the book might make.

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But after her self-penned obituary was published in The Seattle Times , the book bought more than a meal. And we've had evidence of that many times, but rarely more powerful than this particular project. She wants to be an actor.

Resident Evil: The Final Chapter

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    Dual antiplatelet therapy after percutaneous coronary intervention: entering the final chapter?

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