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dc.contributor.advisorAlexa T. McCray, Stephen G. Pauker and John B. Wong.en_US
dc.contributor.authorEvans, J. Stewart (James Stewart)en_US
dc.contributor.otherHarvard University--MIT Division of Health Sciences and Technology.en_US
dc.date.accessioned2011-06-06T17:43:17Z
dc.date.available2011-06-06T17:43:17Z
dc.date.copyright2010en_US
dc.date.issued2010en_US
dc.identifier.urihttp://hdl.handle.net/1721.1/63226
dc.descriptionThesis (S.M.)--Harvard-MIT Division of Health Sciences and Technology, 2010.en_US
dc.descriptionCataloged from PDF version of thesis.en_US
dc.descriptionIncludes bibliographical references (p. 35-38).en_US
dc.description.abstractBackground: The optimal long-term antiplatelet therapy (APT) that balances the benefit of preventing myocardial infarction (MI) with the risk of severe bleeding is unknown in patients greater than one year after drug-eluting stent (DES) placement. Methods: We modeled life expectancy (LE) using published data by building a Markov model to compare several APT strategies composed of aspirin and clopidogrel, both as monotherapy and in various clinically plausible combinations. The base case examined a 65-year old person treated with a DES then continuous aspirin plus clopidogrel (Dual-Rx) for one year without complications. We considered risk of mortality from myocardial infarction and severe bleeding. We used a lifetime horizon and projected LE without quality-adjustment. Results: In the base-case analysis, APT yielding greatest LE was a toss-up between Dual-Rx indefinitely (LE of 13.48 years), clopidogrel indefinitely (LE of 13.45 years), and aspirin indefinitely (LE of 13.42 years); of the strategies considered, no APT was least preferred (LE of 13.36 years). All parameters were varied over plausible ranges in sensitivity analyses, including the duration of future treatment with clopidogrel (base-case, life long). The choice of APT remained a toss-up unless: the annual probability of MI fell below 0.0087 (base-case, 0.013) or the relative risk of systemic bleeding exceeded 1.52 (base case, 1.00), in which case clopidogrel indefinitely was preferred; or the efficacy of clopidogrel to prevent MI fell below 0.09 (base case, 0.20) or the relative risk of clopidogrel for severe gastrointestinal hemorrhage exceeded 3.33 (base case, 2.01), in which case aspirin indefinitely was preferred. Conclusions: For patients with a drug-eluting stent placed greater than one year ago, the antiplatelet therapy which yields the greatest life expectancy is a toss-up between dual antiplatelet therapy (clopidogrel plus aspirin indefinitely), clopidogrel indefinitely, and aspirin indefinitely. However, additional research (including a clinical trial, subgroup analysis, and modeling) is needed.en_US
dc.description.statementofresponsibilityby J. Stewart Evans.en_US
dc.format.extent55 p.en_US
dc.language.isoengen_US
dc.publisherMassachusetts Institute of Technologyen_US
dc.rightsM.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.en_US
dc.rights.urihttp://dspace.mit.edu/handle/1721.1/7582en_US
dc.subjectHarvard University--MIT Division of Health Sciences and Technology.en_US
dc.titleComparing long-term antiplatelet strategies to prevent morbidity and mortality in patients with drug-eluting coronary stentsen_US
dc.typeThesisen_US
dc.description.degreeS.M.en_US
dc.contributor.departmentHarvard University--MIT Division of Health Sciences and Technology
dc.identifier.oclc726650040en_US


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