***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 
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    ***EXAMPLES*** 
    Input: Importance Patients with concomitant peripheral arterial disease ( PAD ) experience worse cardiovascular outcomes after percutaneous coronary intervention ( PCI ) . Objective To assess the efficacy and safety of prolonged ( 24 months ) vs short ( ≤6 months ) dual antiplatelet therapy ( DAPT ) in patients with PAD undergoing PCI . Design , Setting , and Participants This sub analysis of the r and omized Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia Study ( PRODIGY ) trial assessed unselected patients from tertiary care hospitals with stable coronary artery disease or acute coronary syndromes with or without concomitant PAD from December 2006 to December 2008 . Data analysis was performed from January 7 to April 4 , 2016 . Interventions Percutaneous coronary intervention . Main Outcomes and Measures Rates of the primary efficacy end point , composite of death , myocardial infa rct ion , or cerebrovascular accidents , and occurrence of the key safety end point , a composite of Bleeding Academic Research Consortium type 2 , 3 , or 5 . Results This analysis comprised 246 and 1724 patients with and without PAD , respectively . In the patients with PAD , mean ( SD ) age was 73.2 ( 9.2 ) in the prolonged group and 75.7 ( 8.7 ) years in the short DAPT group , and 97 ( 82.2 % ) were male in the prolonged group and 92 ( 71.9 % ) were male in the short DAPT group . In the patients without PAD , mean ( SD ) age was 67.1 ( 11.2 ) years in the prolonged group and 66.8 ( 11.3 ) years in the short DAPT group , and 667 ( 76.8 % ) were male in the prolonged group and 655 ( 76.6 % ) were male in the short DAPT group . Status of PAD was associated with a higher risk of death and ischemic events ( hazard ratio [ HR ] , 2.80 ; 95 % CI , 2.05 - 3.83 ; P < .001 ) . Prolonged vs short DAPT conveyed a lower risk of the primary efficacy end point in patients with PAD ( 19 [ 16.1 % ] vs 35 [ 27.3 % ] ; HR , 0.54 ; 95 % CI , 0.31 - 0.95 ; P = .03 ) but not in patients without PAD ( 81 [ 9.3 % ] vs 63 [ 7.4 % ] ; HR , 1.28 ; 95 % CI , 0.92 - 1.77 ; P = .15 ) , with positive interaction ( P = .01 ) . The risk of definite or probable stent thrombosis was significantly lower in patients with PAD treated with prolonged compared with short DAPT ( HR , 0.07 ; 95 % CI , 0 - 1.21 ; P = .01 ) . Bleeding Academic Research Consortium type 2 , 3 , or 5 bleeding occurred in 6 patients with PAD ( 5.2 % ) receiving prolonged DAPT relative to 8 ( 6.9 % ) of those receiving short DAPT ( HR , 0.77 ; 95 % CI , 0.27 - 2.21 ; P = .62 ) , with a significant interaction ( P = .04 ) compared with patients without PAD . Conclusions and Relevance Peripheral artery disease confers a poor prognosis in patients undergoing PCI in the setting of stable coronary artery disease or acute coronary syndromes . Prolonged DAPT lowers the risk of ischemic events with no apparent bleeding liability in this high-risk group . Trial Registration clinical trials.gov Identifier : NCT00611286 Purpose To present the 12-month results of a trial investigating the effects of dual antiplatelet therapy on  target lesion revascularization ( TLR ) after balloon angioplasty ± stenting in the femoropopliteal segment . Methods A prospect i ve , r and omized , single-center , double-blinded and placebo-controlled clinical trial r and omly assigned 40 patients to receive pre- and postinterventional therapy with aspirin and clopidogrel . Another 40 patients received the same doses of aspirin and placebo instead of clopidogrel . Clopidogrel and placebo were stopped after 6 months , and patients remained on aspirin only . At 12 months after the intervention , 36 clopidogrel patients and 37 placebo patients were reevaluated . Results At 6 months , clopidogrel patients had significantly lower rates of TLR compared to placebo patients [ 2 ( 5 % ) vs. 8 ( 20 % ) , p=0.04 ] . After stopping clopidogrel/placebo after 6 months , there was no significant difference in TLR at 12 months after treatment [ 9 ( 25 % ) clopidogrel vs. 12 ( 32.4 % ) placebo , p=0.35 ] . Mortality was 0 vs. 1 in the placebo group at 6 months ( p=0.32 ) and 0 vs. 3 at 12 months ( p=0.08 ) . Conclusion In contrast to the first report of a reduction in the TLR at 6 months , this advantage of dual antiplatelet therapy does not persist after stopping clopidogrel . Prolonged dual therapy ( > 6 months ) should be considered in patients who are at high risk for restenosis BACKGROUND Clopidogrel is a more potent antiplatelet agent than aspirin , result ing in greater clinical efficacy in patients with atherothrombotic disease . Furthermore , the combination of clopidogrel plus aspirin has been demonstrated to be superior to aspirin alone in the treatment of patients with acute coronary syndromes and after coronary stenting . Whether dual antiplatelet therapy is superior to aspirin monotherapy for high-risk primary prevention and secondary prevention is unknown . METHODS AND RESULTS The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization , Management , and Avoidance ( CHARISMA ) study was design ed to evaluate the efficacy and safety of clopidogrel plus aspirin versus placebo plus aspirin in patients with established coronary , cerebral , or peripheral arterial disease or in patients with multiple risk factors for atherothrombosis who have not yet sustained an ischemic event . This r and omized , international , multicenter , double-blinded , placebo-controlled study has finished enrolling patients worldwide . A total of 15,603 patients will be followed long term . The primary end point will be the composite of vascular death , myocardial infa rct ion , or stroke . Rates of severe bleeding will also be compared between the two arms of the study . CONCLUSIONS This large-scale trial of patients at high risk for atherothrombotic events will allow determination of the value of a strategy of adding clopidogrel to the current st and ard of care , including low-dose aspirin , for a wide spectrum of patients with atherothrombosis OBJECTIVES This study sought to determine whether patients with peripheral arterial disease ( PAD ) experience different reductions in ischemic event and increases in bleeding events with extended duration dual antiplatelet therapy versus those without PAD . BACKGROUND Patients with PAD have increased ischemic and bleeding risks after coronary stenting . METHODS The DAPT ( Dual Antiplatelet Therapy ) study r and omized 11,648 patients free from ischemic and bleeding events 12 months after coronary stenting to continued thienopyridine plus aspirin therapy for an additional 18 months versus aspirin therapy alone . The effects of continued thienopyridine on myocardial infa rct ion ( MI ) or stent thrombosis , major adverse cardiovascular and cerebrovascular events ( death , MI , or stroke ) and bleeding ( GUSTO [ Global Utilization of t-PA and Streptokinase for Occluded Coronary Arteries ] moderate or severe ) were assessed among those with versus without PAD . RESULTS Among 11,648 r and omized patients , 649 ( 5.57 % ) had PAD . Between 12 and 30 months , r and omized patients with PAD had higher rates of MI/stent thrombosis ( 6.03 % vs. 2.92 % ; p < 0.001 ) , major adverse cardiovascular and cerebrovascular events ( 11.65 % vs. 4.62 % ; p < 0.001 ) , and bleeding ( 4.86 % vs. 1.74 % ; p < 0.001 ) . Continued thienopyridine versus placebo was associated with consistent treatment effects for MI/stent thrombosis ( with PAD , HR : 0.63 ; 95 % CI : 0.32 to 1.22 ; without PAD , HR : 0.53 ; 95 % CI : 0.42 , 0.66 ; interaction p = 0.631 ) , major adverse cardiovascular and cerebrovascular events ( with PAD , HR : 1.06 ; 95 % CI : 0.67 to 1.67 ; without PAD , HR : 0.70 ; 95 % CI : 0.59 to 0.84 ; interaction p = 0.103 ) , and bleeding ( with PAD , HR , 1.82 ; 95 % CI : 0.87 to 3.83 ; without PAD , HR : 1.66 ; 95 % CI : 1.23 to 2.24 ; interaction p = 0.811 ) . CONCLUSIONS Among patients undergoing coronary stenting , those with PAD have more ischemic and bleeding events versus those without PAD . Extended duration dual antiplatelet therapy is associated with consistent ischemic benefit and bleeding harm among patients with and without PAD Background — The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain poorly defined . We evaluated the impact of up to 6 versus 24 months of dual-antiplatelet therapy in a broad all-comers patient population receiving a balanced proportion of Food and Drug Administration – approved drug-eluting or bare-metal stents . Methods and Results — We r and omly assigned 2013 patients to receive bare-metal , zotarolimus-eluting , paclitaxel-eluting , or everolimus-eluting stent implantation . At 30 days , patients in each stent group were r and omly allocated to receive up to 6 or 24 months of clopidogrel therapy in addition to aspirin . The primary end point was a composite of death of any cause , myocardial infa rct ion , or cerebrovascular accident . The cumulative risk of the primary outcome at 2 years was 10.1 % with 24-month dual-antiplatelet therapy compared with 10.0 % with 6-month dual-antiplatelet therapy ( hazard ratio , 0.98 ; 95 % confidence interval , 0.74–1.29 ; P=0.91 ) . The individual risks of death , myocardial infa rct ion , cerebrovascular accident , or stent thrombosis did not differ between the study groups ; however , there was a consistently greater risk of hemorrhage in the 24-month clopidogrel group according to all prespecified bleeding definitions , including the recently proposed Bleeding Academic Research Consortium classification . Conclusions — A regimen of 24 months of clopidogrel therapy in patients who had received a balanced mixture of drug-eluting or bare-metal stents was not significantly more effective than a 6-month clopidogrel regimen in reducing the composite of death due to any cause , myocardial infa rct ion , or cerebrovascular accident . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00611286 This study assesses the effects of invasive procedures , hemostatic and clinical variables , and doses of recombinant tissue plasminogen activator ( t-PA ) on  hemorrhagic events in the thrombolysis in myocardial ischemia ( TIMI ) , phase 1B clinical trial ( n = 1,425 ) . Patients seen within 24 hours of the onset of ischemic chest pain at rest were r and omized using a 2 x 2 factorial design for comparison of : ( 1 ) t-PA versus placebo as initial therapy , and ( 2 ) an early invasive ( coronary arteriography with percutaneous angioplasty , if feasible ) versus an early conservative strategy ( coronary arteriography followed by revascularization if initial medical therapy failed ) . All patients received conventional medication for acute ischemic syndromes , including heparin , aspirin , beta blockers , nitrates , and calcium antagonists . The total dose of t-PA or placebo was 0.8 mg/kg , up to a maximum dose of 80 mg . In patients treated with t-PA , major and minor hemorrhagic events were more common than among those assigned to placebo ( p < 0.001 ) . Patients assigned to the invasive strategy arm had a higher hemorrhagic event rate than the noninvasive strategy , although the difference was not significant ( p = 0.026 ) . Patients > 75 years of age had higher intracranial hemorrhage rates  than those < 75 years of age ( 
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Conclusions : DAPT appears to be beneficial for preventing complications after revascularization in PAD , including thrombotic failure of the intervention .