***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Dual antiplatelet therapy with both aspirin and clopidogrel is increasingly used after coronary artery bypass grafting ( CABG ) ; however , little is known about the safety or efficacy . We sought to determine the relationship between postoperative clopidogrel and clinical and angiographic outcomes following CABG . We evaluated 3,014 patients from PREVENT IV who underwent CABG at 107 US sites .  Postoperative antiplatelet therapy was left to physician discretion . Risk-adjusted angiographic and clinical outcomes were compared in patients taking and not taking clopidogrel 30 days post-CABG . At 30 days , 633 ( 21 % ) patients were taking clopidogrel . Clopidogrel users were more likely to have peripheral vascular ( 15 vs. 11 % ) and cerebrovascular disease ( 17 vs. 11 % ) , prior myocardial infa rct ion ( MI ) ( 46 vs. 41 % ) , and  off-pump surgery  ( 33 vs. 18 % ) . Clopidogrel use was associated with statistically insignificant higher graft failure ( adjusted odds ratio 1.3 ; 95 % confidence interval [ CI ] [ 1.0 , 1.7 ] ; P = 0.05 ) . At 5-year follow-up , clopidogrel use was associated with similar composite rates of death , MI , or revascularization ( 27 vs. 24 % ; adjusted hazard ratio 1.1 ; 95 % CI [ 0.9 , 1.4 ] ; P = 0.38 ) compared with those not using clopidogrel . There was an interaction between use of cardiopulmonary bypass and clopidogrel with a trend toward lower 5-year clinical events with clopidogrel in patients undergoing off-pump CABG . In this observational analysis , clopidogrel use was not associated with better 5-year outcomes following CABG . There may be better outcomes with clopidogrel among patients having off-pump surgery . Adequately powered r and omized clinical trials are needed to determine the role of dual antiplatelet therapy after CABG Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background —Antiplatelet therapy and antithrombin therapy have been demonstrated to reduce the risk of cardiac events in patients presenting with acute coronary syndrome , yet all effective therapies also increase the risk of bleeding . Methods and Results —In the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events ( CURE ) trial , 12 562 patients were r and omized to clopidogrel or placebo  in addition to  aspirin  , and the primary outcome was cardiovascular ( CV ) death , myocardial infa rct ion ( MI ) , or stroke . The benefits were consistent among those undergoing percutaneous coronary intervention ( PCI ) [ 9.6 % for clopidogrel , 13.2 % for placebo ; relative risk ( RR ) , 0.72 ; 95 % CI , 0.57 to 0.90 ] , coronary artery bypass grafting ( CABG ) surgery ( 14.5 % for clopidogrel 16.2 % for placebo ; RR , 0.89 ; 95 % CI , 0.71 to 1.11 ) , and medical therapy only ( 8.1 % for clopidogrel , 10.0 % for placebo ; RR , 0.80 ; 95 % CI , 0.69 to 0.92 ; test for interaction among strata , 0.53 ) . For CABG during the initial hospitalization ( 530 for placebo , 485 for clopidogrel ) , the frequency of CV death , MI or stroke before CABG was 4.7 % for placebo and 2.9 % for clopidogrel ( RR , 0.56 ; 95 % CI , 0.29 to 1.08 ) . For the entire study , there was a 1 % excess of major bleeding but no significant excess of life-threatening bleeding . Among patients undergoing CABG , the rates of life-threatening bleeding were 5.6 % for clopidogrel and 4.2 % for placebo ( RR , 1.30 ; 95 % CI , 0.91 to 1.95 ; both nonsignificant ) . Conclusions —The benefits versus risks of early and long-term clopidogrel therapy ( freedom from CV death , MI , stroke , or life-threatening bleeding ) are similar in those undergoing revascularization ( CABG or PCI ) and in the study population as a whole . Overall , the benefits of starting clopidogrel on admission appear to outweigh the risks , even among those who proceed to CABG during the initial hospitalization BACKGROUND Despite improvements in the emergency treatment of myocardial infa rct ion ( MI ) , early mortality and morbidity remain high . The antiplatelet agent clopidogrel adds to the benefit of aspirin in acute coronary syndromes without ST-segment elevation , but its effects in patients with ST-elevation MI were unclear . METHODS 45,852 patients admitted to 1250 hospitals within 24 h of suspected acute MI onset were r and omly allocated clopidogrel 75 mg daily ( n=22,961 ) or matching placebo ( n=22,891 ) in addition to aspirin 162 mg daily . 93 % had ST-segment elevation or bundle branch block , and 7 % had ST-segment depression . Treatment was to continue until discharge or up to 4 weeks in hospital ( mean 15 days in survivors ) and 93 % of patients completed it . The two prespecified co- primary outcomes were : ( 1 ) the composite of death , reinfa rct ion , or stroke ; and ( 2 ) death from any cause during the scheduled treatment period . Comparisons were by intention to treat , and used the log-rank method . This trial is registered with Clinical Trials.gov , number NCT00222573 . FINDINGS Allocation to clopidogrel produced a highly significant 9 % ( 95 % CI 3 - 14 ) proportional reduction in death , reinfa rct ion , or stroke ( 2121 [ 9.2 % ] clopidogrel vs 2310 [ 10.1 % ] placebo ; p=0.002 ) , corresponding to nine ( SE 3 ) fewer events per 1000 patients treated for about 2 weeks . There was also a significant 7 % ( 1 - 13 ) proportional reduction in any death ( 1726 [ 7.5 % ] vs 1845 [ 8.1 % ] ; p=0.03 ) . These effects on death , reinfa rct ion , and stroke seemed consistent across a wide range of patients and independent of other treatments being used . Considering all fatal , transfused , or cerebral bleeds together , no significant excess risk was noted with clopidogrel , either overall ( 134 [ 0.58 % ] vs 125 [ 0.55 % ] ; p=0.59 ) , or in patients aged older than 70 years or in those given fibrinolytic therapy . INTERPRETATION In a wide range of patients with acute MI , adding clopidogrel 75 mg daily to aspirin and other st and ard treatments ( such as fibrinolytic therapy ) safely reduces mortality and major vascular events in hospital , and should be considered routinely BACKGROUND Despite current treatments , patients who have acute coronary syndromes without ST-segment elevation have high rates of major vascular events . We evaluated the efficacy and safety of the antiplatelet agent clopidogrel when given with aspirin in such patients . METHODS We r and omly assigned 12,562 patients who had presented within 24 hours after the onset of symptoms to receive clopidogrel ( 300 mg immediately , followed by 75 mg once daily ) ( 6259 patients ) or placebo ( 6303 patients ) in addition  to aspirin for 3 to 12 months . RESULTS The first primary outcome --a composite of death from cardiovascular causes , nonfatal myocardial infa rct ion , or stroke -- occurred in 9.3 percent of the patients in the clopidogrel group and 11.4 percent of the patients in the placebo group ( relative risk with clopidogrel as compared with placebo , 0.80 ; 95 percent confidence interval , 0.72 to 0.90 ; P<0.001 ) . The second primary outcome --the first primary outcome or refractory ischemia -- occurred in 16.5 percent of the patients in the clopidogrel group and 18.8 percent of the patients in the placebo group ( relative risk , 0.86 ; 95 percent confidence interval , 0.79 to 0.94 ; P<0.001 ) . The percentages of patients with in-hospital refractory or severe ischemia , heart failure , and revascularization procedures were also significantly lower with clopidogrel . There were significantly more patients with major bleeding in the clopidogrel group than in the placebo group ( 3.7 percent vs. 2.7 percent ; relative risk , 1.38 ; P=0.001 ) , but there were not significantly more patients with episodes of life-threatening bleeding ( 2.2 percent [ corrected ] vs. 1.8 percent ; P=0.13 ) or hemorrhagic strokes ( 0.1 percent vs. 0.1 percent ) . CONCLUSIONS The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation . However , the risk of major bleeding is increased among patients treated with clopidogrel Objective To evaluate efficacy and safety outcomes in patients in the PLATelet inhibition and patient Outcomes ( PLATO ) trial who at r and omisation were planned for a non-invasive treatment strategy . Design Pre-specified analysis of pre-r and omisation defined subgroup of prospect i ve r and omised clinical trial . Setting 862 centres in 43 countries . Participants 5216 ( 28 % ) of 18 624 patients admitted to hospital for acute coronary syndrome who were specified as planned for non-invasive management . Interventions R and omised treatment with ticagrelor ( n=2601 ) versus clopidogrel ( 2615 ) . Main outcome measurements Primary composite end point of cardiovascular death , myocardial infa rct ion , and stroke ; their individual components ; and PLATO defined major bleeding during one year . Results 2183 ( 41.9 % ) patients had coronary angiography during their initial hospital admission , 1065 ( 20.4 % ) had percutaneous coronary intervention , and 208 ( 4.0 % ) had coronary artery bypass surgery . Cumulatively , 3143 ( 60.3 % ) patients had been managed non-invasively by the end of follow-up . The incidence of the primary end point was lower with ticagrelor than with clopidogrel ( 12.0 % ( n=295 ) v 14.3 % ( 346 ) ; hazard ratio 0.85 , 95 % confidence interval 0.73 to 1.00 ; P=0.04 ) . Overall mortality was also lower ( 6.1 % ( 147 ) v 8.2 % ( 195 ) ; 0.75 , 0.61 to 0.93 ; P=0.01 ) . The incidence of total major bleeding ( 11.9 % ( 272 ) v 10.3 % ( 238 ) ; 1.17 , 0.98 to 1.39 ; P=0.08 ) and non-coronary artery bypass grafting related major bleeding ( 4.0 % ( 90 ) v 3.1 % ( 71 ) ; 1.30 , 0.95 to 1.77 ; P=0.10 ) was numerically higher with ticagrelor than with clopidogrel . Conclusions In patients with acute coronary syndrome initially intended for non-invasive management , the benefits of ticagrelor over clopidogrel were consistent with those from the overall PLATO results , indicating the broad benefits of P2Y12 inhibition with ticagrelor regardless of intended management strategy . Trial registration Clinical trials NCT00391872 Coronary artery bypass grafting (C 
    Output:
    
While DAPT has been associated with lower CV mortality in observational sample s undergoing CABG , such findings were not replicated in RCTs .
Lower rates of SVG occlusion with DAPT are offset by a higher rate of major bleeding