Benefit of Long-Term Dual Anti-Platelet Therapy in Patients Treated With Drug-Eluting Stents: From the NHLBI Dynamic Registry

Mulukutla, Suresh; Marroquin, Oscar C.; Vlachos, Helen; Selzer, Faith; Toma, Catalin; Kip, Kevin E.; Abbott, J. Dawn; Holper, Elizabeth M.; Lee, Joon S.; Khandhar, Sameer; Kutcher, Michael A.; Kelsey, Sheryl F.; Smith, Conrad; Faxon, David P.; Williams, David O.

doi:10.1016/j.amjcard.2012.10.030

Cited by 38 publications

(30 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We performed landmark analyses to evaluate the association of thienopyridine use with outcomes. Landmark analyses estimate time‐to‐event probabilities in different treatment groups conditional on group membership at a pre‐specified point in time (ie, the “landmark” time point), and has been used in several previous studies of thienopyridine use and outcomes . We chose 3 landmark time points: 3, 6, and 12 months after the index hospitalization discharge date, since our available data overlap with the time period when guidelines changed from recommending 3 to 6 months of thienopyridine use after coronary stenting with DES to at least 12 months .…”

Section: Methodsmentioning

confidence: 99%

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Chang

Montez‐Rath

Shen

et al. 2014

JAHA

View full text Add to dashboard Cite

BackgroundCoronary stenting in patients on dialysis has increased by nearly 50% over the past decade, despite heightened risks of associated stent thrombosis and bleeding relative to the general population. We examined clopidogrel, prasugrel or ticlopidine use after percutaneous coronary intervention (PCI) with stenting in patients on dialysis. We conducted 3‐, 6‐, and 12‐month landmark analyses to test the hypothesis that thienopyridine discontinuation prior to those time points would be associated with higher risks of death, myocardial infarction, or repeat revascularization, and a lower risk of major bleeding episodes compared with continued thienopyridine use.Methods and ResultsUsing the US Renal Data System, we identified 8458 patients on dialysis with Medicare Parts A+B+D undergoing PCI with stenting between July 2007 and December 2010. Ninety‐nine percent of all thienopyridine prescriptions were for clopidogrel. At 3 months, 82% of patients who received drug‐eluting stents (DES) had evidence of thienopyridine use. These proportions fell to 62% and 40% at 6 and 12 months, respectively. In patients who received a bare‐metal stent (BMS), 70%, 34%, and 26% of patients had evidence of thienopyridine use at 3, 6, and 12 months, respectively. In patients who received a DES, there was a suggestion of higher risks of death or myocardial infarction associated with thienopyridine discontinuation in the 3‐, 6‐, and 12‐months landmark analyses, but no higher risk of major bleeding episodes. In patients who received a BMS, there were no differences in death or cardiovascular events, and possibly lower risk of major bleeding with thienopyridine discontinuation in the 3‐ and 6‐month landmark analyses.ConclusionsThe majority of patients on dialysis who undergo PCI discontinue thienopyridines before 1 year regardless of stent type. While not definitive, these data suggest that longer‐term thienopyridine use may be of benefit to patients on dialysis who undergo PCI with DES.

show abstract

Section: Methodsmentioning

confidence: 99%

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Chang

Montez‐Rath

Shen

et al. 2014

JAHA

View full text Add to dashboard Cite

show abstract

“…4,16,17 The current recommendation is the lack of randomized trial data. 14,15 However, the optimal or minimal necessary duration of DAPT remains undetermined.…”

Section: Discussionmentioning

confidence: 99%

Optimal Duration of Dual Antiplatelet Therapy After Drug-eluting Stent Implantation

Liu

Chen

Huang

et al. 2014

Journal of Cardiovascular Pharmacology

View full text Add to dashboard Cite

The results indicate that short-term DAPT do not increase the risk of cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, major bleeding, cerebrovascular accidents, and all-cause death at 12 months after implantation of DES compared with current standard-term DAPT. However, only 3 studies with second generation of DES are included in this meta-analysis. Further well-designed studies are still needed.

show abstract

“…10,12,36,37 Moreover, in many observational studies, the definition of how the landmark is operationalized is rarely stated. This study explicitly describes medication use and discontinuation definitions and compares their implications for study bias.…”

Section: Discussionmentioning

confidence: 99%

Defining Exposure in Observational Studies Comparing Outcomes of Treatment Discontinuation

Krumme

Glynn

Schneeweiß

et al. 2018

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

BACKGROUND:Continuation of antiplatelet therapy beyond 12 months after a drug-eluting stent procedure reduced the risk of a major adverse cardiovascular and cerebrovascular event (MACCE) in the DAPT trial (Dual Antiplatelet Therapy). Observational studies have evaluated outcomes related to different durations of therapy but are susceptible to bias. METHODS AND RESULTS:Using deidentified claims from commercially insured and Medicare populations in the United States, we compared how increasingly stringent definitions of exposure affect associations between antiplatelet continuation versus discontinuation and MACCE, myocardial infarction, and intracerebral hemorrhage or gastrointestinal bleeding in patients meeting DAPT trial inclusion criteria between 2004 and 2013. Therapy continuation at 12 months was defined as (1) having antiplatelet supply on hand versus not (landmark time); (2) refilling within 30 days versus not among individuals with antiplatelet supply; (3) criteria 2 plus continuous prior antiplatelet use; and (4) criteria 2 and 3 plus a cardiologist visit in months 10 to 12. Propensity scoreadjusted hazard ratios were compared. Cohort sizes were 53 679, 27 524, 16 971, and 7948, respectively, of which 20% were discontinuers on average. Increasing restriction led to progressively larger associations with continued treatment: cohort 1 MACCE hazard ratio, 0.79 (0.73, 0.87); myocardial infarction, 0.74 (0.65, 0.83); bleed, 1.03 (0.96, 1.11) versus cohort 4 MACCE hazard ratio, 0.66 (0.48, 0.91); myocardial infarction, 0.56 (0.37, 0.86); bleed, 1.24 (0.95, 1.61). Estimates trended toward DAPT trial estimates and were associated with reduced levels of exposure misclassification. CONCLUSIONS:In an example of long-term antiplatelet use, increasing restrictions on the definition of therapy continuation yielded results consistent with trial estimates by reducing exposure misclassification.

show abstract

Benefit of Long-Term Dual Anti-Platelet Therapy in Patients Treated With Drug-Eluting Stents: From the NHLBI Dynamic Registry

Cited by 38 publications

References 27 publications

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Thienopyridine Use After Coronary Stenting in Low Income Patients Enrolled in Medicare Part D Receiving Maintenance Dialysis

Optimal Duration of Dual Antiplatelet Therapy After Drug-eluting Stent Implantation

Defining Exposure in Observational Studies Comparing Outcomes of Treatment Discontinuation

Contact Info

Product

Resources

About