Overall, dose switching or discontinuation was more common in the high-dose compared with low-dose aspirin group, but the pattern was not modified by P2Y12 inhibitor use. We found no interaction in the relative effectiveness and safety of high- versus low-dose aspirin by P2Y12 inhibitor use. P2Y12 inhibitor use was associated with higher risk of the primary effectiveness end point (10.86% versus 6.31% adjusted hazard ratio, 1.40 ) but was not associated with bleeding (0.95% versus 0.53% adjusted HR, 1.42 ). Of 13 815 (91.6%) participants with available data, 3051 (22.1%) were receiving clopidogrel (2849 ) or prasugrel (203 ) at baseline. We used multivariable Cox regression to compare the relative effectiveness and safety of aspirin dose within P2Y12 and non-P2Y12 groups. The primary effectiveness end point was a composite of death, myocardial infarction, or stroke and the primary safety end point was major bleeding requiring blood transfusions. Methods and Results Participants in ADAPTABLE were stratified according to baseline use of clopidogrel or prasugrel (P2Y12 group). Whether concomitant P2Y12 inhibitor therapy modifies the effect of aspirin dose on clinical events remains unclear.
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