Adverse Events After Stopping Clopidogrel in Post–Acute Coronary Syndrome Patients

Abstract

Background-A prior study from the Veterans Health Administration found a clustering of cardiovascular events after clopidogrel cessation. We sought to confirm and expand these findings. Methods and Results-This was a retrospective cohort study of 2017 patients with acute coronary syndrome discharged on clopidogrel from an integrated health care delivery system. Rates of all-cause mortality or acute myocardial infarction (MI) within 1 year after stopping clopidogrel were assessed among patients who did not have an event before stopping clopidogrel. Death/MI occurred in 4.3% (nϭ71) of patients. The rates of death/MI were 3.07, 1.62, 0.70, and 0.95 per 10 000 patient-days for the time intervals of 0 to 90, 91 to 180, 181 to 270, and 271 to 360 days after stopping clopidogrel. In multivariable analysis, the 0-to 90-day interval after stopping clopidogrel was associated with higher risk of death/MI (incidence rate ratio, 2.74; 95% confidence interval, 1.69 to 4.44) compared with 91-to 360-day interval.There was a similar trend of increased events after stopping clopidogrel for various subgroups (women versus men, medical therapy versus percutaneous coronary intervention, stent type, and Ն6 months or Ͻ6 months of clopidogrel treatment). Among patients taking clopidogrel but stopping ACE inhibitor medications, the event rates were similar in the 0-to 90-day versus the 91-to 360-day interval (2.67 versus 2.91 per 10 000 patient-days; Pϭ0.91). Conclusions-We observed a clustering of adverse events in the 0 to 90 days after stopping clopidogrel. This clustering of events was not present among patients stopping ACE inhibitors. These findings are consistent with a possible rebound platelet hyper-reactivity after stopping clopidogrel and additional platelet studies are needed to confirm this effect. (Circ Cardiovasc Qual Outcomes. 2010;3:303-308.)

Clopidogrel Use and Hospital Quality in Medically Managed Patients With Non–ST-Segment–Elevation Myocardial Infarction

“…However, prior studies have demonstrated that gaps in both prescription and use of secondary prevention medications, such as clopidogrel, at hospital discharge, are often magnified rather than reduced in the outpatient setting. 13,14 Second, incomplete or inaccurate documentation of clopidogrel contraindication could cause our characterization of a gap to be overstated. However, data abstraction for the ACTION Registry-GWTG is subject to data quality methods, which minimizes this potential bias.…”

Legacy of blood: does prasugrel inhibit megakaryocytes and do juvenile platelets inherit this inhibition?

“…Recurrence of ischemic effects following cessation of P2Y 12 inhibitors has been described [17][18][19] and "rebound" platelet hyperreactivity after discontinuation of thienopyridines has been proposed to explain it. While it is not surprising that platelet reactivity increases relative to reactivity while on treatment with thienopyridines (i.e.…”

Gestion péri-opératoire des patients traités par antithrombotiques en chirurgie orale. Argumentaire

“…Des observations [165,166] similaires sont rapportées avec un arrêt prématuré ou inaproprié du clopidogrel.…”

“…Une hémostase chirurgicale simple associant hémostatique local et sutures permet de contrôler efficacement le risque de saignement péri-opératoire. Par ailleurs, des études [165,166] ont montré chez des patients porteurs de stents, la survenue d'événement thrombotique dans une période de 1 à 3 mois suite à l'arrêt de la bithérapie (arrêt du clopidogrel et poursuite de l'aspirine). Ceci soulève la question d'un possible « phénomène de rebond prothrombotique » à l'arrêt du clopidogrel [257], effet délétère également évoqué avec l'aspirine [60,102,103] mais dont la physiopathologie n'est toujours pas élucidée [18].…”