***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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    Input: AIMS In the dual antiplatelet therapy ( DAPT ) study , continued thienopyridine beyond 12 months after drug-eluting stent placement was associated with increased mortality compared with placebo . We sought to evaluate factors related to mortality in r and omized patients receiving either drug-eluting or bare metal stents in the DAPT study . METHODS AND RESULTS Patients were enrolled after coronary stenting  , given thienopyridine and aspirin for 12 months , r and omly assigned to continued thienopyridine or placebo for an additional 18 months ( while taking aspirin ) , and subsequently treated with aspirin alone for another 3 months . A blinded independent adjudication committee evaluated deaths . Among 11 648 r and omized patients , rates of all-cause mortality rates were 1.9 vs. 1.5 % ( continued thienopyridine vs. placebo , P = 0.07 ) , cardiovascular mortality , 1.0 vs. 1.0 % ( P = 0.97 ) , and non-cardiovascular mortality , 0.9 vs. 0.5 % ( P = 0.01 ) over the r and omized period ( Months 12 - 30 ) . Rates of fatal bleeding were 0.2 vs. 0.1 % ( P = 0.81 ) , and deaths related to any prior bleeding were 0.3 vs. 0.2 % ( P = 0.36 ) , Months 12 - 33 ) . Cancer incidence did not differ ( 2.0 vs. 1.6 % , P = 0.12 ) . Cancer-related deaths occurred in 0.6 vs. 0.3 % ( P = 0.02 ) and were rarely related to bleeding ( 0.1 vs. 0 , P = 0.25 ) . After excluding those occurring in patients with cancer diagnosed before enrolment , rates were 0.4 vs. 0.3 % ( P = 0.16 ) . CONCLUSION Bleeding accounted for a minority of deaths among patients treated with continued thienopyridine .  Cancer-related death in association with thienopyridine therapy was mainly not related to bleeding and may be a chance finding . Caution is warranted when considering extended thienopyridine in patients with advanced cancer . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00977938 Background — The impact of changing demographics on causes of  long-term death after percutaneous coronary intervention ( PCI )  remains incompletely defined . Methods and Results — We evaluated trends in cause-specific long-term mortality after  index PCI performed at a single center from 1991 to 2008 . Deaths were ascertained by scheduled prospect i ve surveillance . Cause was determined via telephone interviews , medical records , autopsy reports , and death certificates . Competing-risks analysis of cause-specific mortality was performed using 3 time periods of PCI ( 1991–1996 , 1997–2002 , and 2003–2008 ) . Final follow-up was December 31 , 2012 . A total of 19 077 patients survived index PCI hospitalization , of whom 6988 subsequently died ( 37 % , 4.48 per 100 person-years ) . Cause was determined in 6857 ( 98.1 % ) . Across 3 time periods , there was a 33 % decline in cardiac deaths at 5 years after PCI ( incidence : 9.8 % , 7.4 % , and 6.6 % ) but a 57 % increase in noncardiac deaths ( 7.1 % , 8.5 % , and 11.2 % ) . Only 36.8 % of deaths in the recent era were cardiac . Similar trends were observed regardless of age , extent of coronary disease , or PCI indication . After adjustment for baseline variables , there was a 50 % temporal decline in cardiac mortality but no change in noncardiac mortality . The decline in cardiac mortality was driven by fewer deaths from myocardial infa rct ion/sudden death ( P<0.001 ) but not heart failure ( P=0.85 ) . The increase in noncardiac mortality was primarily attributable to cancer and chronic diseases ( P<0.001 ) . Conclusions — This study found a marked temporal switch from predominantly cardiac to predominantly noncardiac causes of death after PCI over 2 decades . The decline in cardiac mortality was independent of changes in baseline clinical characteristics . These findings have implication s for patient care and clinical trial design OBJECTIVES : We evaluated the effect of the use of aspirin , nonsteroidal anti-inflammatory drugs ( NSAIDS ) , and anticoagulants on the performance of immunochemical fecal occult blood test ( I-FOBT ) . METHODS : A prospect i ve , cross-sectional study of 1,221 ambulatory patients having total colonoscopy after preparing three I-FOBTs . Information regarding the use of medications was collected from the health medical organization ( HMO ) data base . I-FOBT was analyzed with the OC-MICRO instrument using both ≥75 and 100 ngHb/ml of buffer thresholds to determine positivity . RESULTS : Colorectal cancer ( CRC ) was found in 17 and advanced adenomatous polyp ( AAP ) in 97 patients . A total of 212 patients were using aspirin/NSAIDS at the time of I-FOBT testing . Qualitative analysis for the detection of AAP/CRC reveals a trend for an increased sensitivity  with aspirin/NSAIDS use . At the threshold 75 ng/ml for positivity , the sensitivity for the detection of AAP/CRC was 66.7 % for aspirin/NSAIDS use vs. 51.2 % for nondrug takers ( P=0.20 ) , and at the threshold of 100 ng/ml , the sensitivity was 66.7 vs. 46.5 % ( P=0.09 ) . The specificity , however , was not affected by the use of aspirin/NSAIDS . At the threshold of 75 ng/ml for positivity , the specificity for the detection of AAP/CRC was 89.5 % for aspirin/NSAIDS use vs. 91.2 % for nondrug takers ( P=0.47 ) , and at the threshold of 100 ng/ml , the specificity was 92.17 vs. 93.0 % ( P=0.69 ) . A total of 33 patients were using antithrombotics/coagulants  at the time of I-FOBT testing . This group was small ; however , it appears that their use was also associated with a trend for increased sensitivity and no change in specificity . CONCLUSIONS : The use of aspirin/NSAIDS and anticoagulants was associated with a trend for increased sensitivity with no change in specificity for the detection of AAP/CRC . This study suggests that there is no need to stop these agents before I-FOBT testing 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 BACKGROUND Dual-antiplatelet therapy with aspirin and a thienopyridine is a cornerstone of treatment to prevent thrombotic complications of acute coronary syndromes and percutaneous coronary intervention . METHODS To compare prasugrel , a new thienopyridine , with clopidogrel , we r and omly assigned 13,608 patients with moderate-to-high-risk acute coronary syndromes with scheduled percutaneous coronary intervention to receive prasugrel ( a 60-mg loading dose and a 10-mg daily maintenance dose ) or clopidogrel ( a 300-mg loading dose and a 75-mg daily maintenance dose ) , for 6 to 15 months . The primary efficacy end point was death from cardiovascular causes , nonfatal myocardial infa rct ion , or nonfatal stroke . The key safety end point was major bleeding . RESULTS The primary efficacy end point occurred in 12.1 % of patients receiving clopidogrel and 9.9 % of patients receiving prasugrel ( hazard ratio for prasugrel vs. clopidogrel , 0.81 ; 95 % confidence interval [ CI ] , 0.73 to 0.90 ; P<0.001 ) . We also found significant reductions in the prasugrel group in the rates of myocardial infa rct ion ( 9.7 % for clopidogrel vs. 7.4 % for prasugrel ; P<0.001 ) , urgent target-vessel revascularization ( 3.7 % vs. 2.5 % ; P<0.001 ) , and stent thrombosis ( 2.4 % vs. 1.1 % ; P<0.001 ) . Major bleeding was observed in 2.4 % of patients receiving prasugrel and in 1.8 % of patients receiving clopidogrel ( hazard ratio , 1.32 ; 95 % CI , 1.03 to 1.68 ; P=0.03 ) . Also greater in the prasugrel group was the rate of life-threatening bleeding ( 1.4 % vs. 0.9 % ; P=0.01 ) , including nonfatal bleeding ( 1.1 % vs. 0.9 % ; hazard ratio , 1.25 ; P=0.23 ) and fatal bleeding ( 0.4 % vs. 0.1 % ; P=0.002 ) . CONCLUSIONS In patients with acute coronary syndromes with scheduled percutaneous coronary intervention , prasugrel therapy was associated with significantly reduced rates of ischemic events , including stent thrombosis , but with an increased risk of major bleeding , including fatal bleeding . Overall mortality did not differ significantly between treatment groups . ( Clinical Trials.gov number , NCT00097591 [ Clinical Trials.gov ] . PURPOSE Concerns were raised about the safety of antiplatelet thienopyridine derivatives after a r and omized control trial reported increased risks of cancer and cancer deaths in  prasugrel users . We investigate whether clopidogrel , a widely used thienopyridine derivative , was associated with increased risk of cancer-specific or all-cause mortality in cancer patients . METHODS Colorectal , breast and prostate cancer patients , newly diagnosed from 1998 to 2009 , were identified from the National Cancer Data Repository . Cohorts were linked to the UK Clinical Practice Research Data link , providing prescription records , and to the Office of National Statistics mortality data ( up to 2012 ) . Unadjusted and adjusted hazard ratios ( HRs ) for cancer-specific and all-cause mortality in post-diagnostic clopidogrel users were calculated using time-dependent Cox regression models . RESULTS The analysis included 10 359 colorectal , 17 889 breast and 13 155 prostate cancer patients . There was no evidence of an increase in cancer-specific mortality in clopidogrel users with colorectal ( HR = 0.98 95 % confidence interval ( CI ) 0.77 , 1.24 ) or prostate cancer ( HR = 1.03 95%CI 0.82 , 1.28 ) . There was limited evidence of an increase in breast cancer patients ( HR = 1.22 
    Output:
    
Further analyses examining clopidogrel showed no significant association with cancer event rate or malignancy-related death .
Conclusions Our results suggest that there is currently insufficient evidence to suggest that thienopyridine exposure is associated with an increased risk of cancer event rate or mortality