Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study

Thim, Troels; Johansen, Martin Berg; Chisholm, Gro; Schmidt, Morten; Kaltoft, Anne; Sørensen, Henrik Toft; Thuesen, Leif; Kristensen, Steen Dalby; Bøtker, Hans Erik; Krusell, Lars Romer; Lassen, Jens Flensted; Thayssen, Per; Jensen, Lisette Okkels; Tilsted, Hans‐Henrik; Mæng, Michael

doi:10.1186/1471-2261-14-100

Cited by 28 publications

(19 citation statements)

References 40 publications

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“…Patient antithrombotic medication adherence following placement of a drug-eluting stent (DES) is a challenge as 5.4% of patients never fill a prescription and on average, patients have their medication only 81% of the time over a year (1). Non-adherence to antithrombotic medication leads to a nine times greater risk of death within the first year of the stent placement (2–5).…”

Section: Introductionmentioning

confidence: 99%

Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent

Shah

Dileep

Dickens

et al. 2016

Front. Public Health

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Background/aimsThis study’s objective was to evaluate a patient-centered educational electronic tablet application, “My Interventional Drug-Eluting Stent Educational App” (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual.MethodsIn a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits.ResultsRelative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (<80% MPR). The psychological data revealed a single imbalance in anxiety between the control and interventional groups. On average, interventional participants spent 21 min using MyIDEA.DiscussionConsumer health informatics has enabled us to engage patients with their health data using novel methods. Consumer health technology needs to focus more on patient knowledge and engagement to improve long-term health. MyIDEA takes a unique approach in targeting DAPT from the onset.ConclusionMyIDEA leverages patient-centered information with clinical care and the electronic health record highlighting the patients’ role as a team member in their own health care. The patients think critically about adverse events and how to solve issues before leaving the hospital.

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Section: Introductionmentioning

confidence: 99%

Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent

Shah

Dileep

Dickens

et al. 2016

Front. Public Health

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“…The level of adherence was estimated based on patients' declarations only, which was a major limitation of the study. A different study reported the increase of MACE due to discontinuation of clopidogrel within the initial 3-month period, but not after 3 to 12 months [46].…”

Section: Adherence After Ami Treated By Pcimentioning

confidence: 99%

Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications

Świeczkowski

Mogielnicki²,

Cwalina

et al. 2013

Cardiol J

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“…Recently, some studies have suggested increased risk of recurrent cardiovascular events after planned cessation of clopidogrel therapy. It has been postulated that it could be due to increased platelet reactivity compared with pre-treatment values (platelet rebound) [1,[5][6][7][8][9]. However, in many previous studies [3,4,10], platelet reactivity before introducing clopidogrel was not assessed, and therefore it is unclear whether platelet reactivity after withdrawal was any higher than pre-treatment levels [1].…”

Section: Introductionmentioning

confidence: 86%

A single-centre, randomised study on platelet reactivity after abrupt or gradual discontinuation of long-term clopidogrel therapy in patients after percutaneous coronary intervention

et al. 2016

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A b s t r a c tBackground: Clinical studies have suggested increased risk of thrombotic events after planned cessation of clopidogrel therapy, due to increased platelet reactivity (platelet rebound); however, in many studies platelet function was not assessed before introducing clopidogrel. Patients who are scheduled to stop clopidogrel therapy, do it abruptly, so a gradual drug cessation might provide a beneficial treatment strategy. Aim:To determine whether a clopidogrel discontinuation results in platelet rebound hyperaggregability with increased activity compared to pre-treatment values and to assess whether abrupt or tapering clopidogrel cessation may affect platelet reactivity. Methods:Patients with stable coronary artery disease (n = 49), on chronic acetylsalicylic acid treatment, who underwent coronary angiography, and were scheduled for elective percutaneous coronary intervention with stent implantation were enrolled. Patients were randomised to either a tapering clopidogrel discontinuation during a two-week period (tapering group, n = 25) or abrupt drug cessation (abrupt group, n = 24). After 12 months of dual antiplatelet therapy with clopidogrel and acetylsalicylic acid, we performed three follow-up visits with blood sampling. Platelet aggregation was assessed using a multiple electrode aggregometer at inclusion, at cessation day, and seven and 14 days after complete clopidogrel discontinuation. The primary endpoint was the level of adenosine-diphosphate (ADP)-induced platelet aggregation. We also analysed platelet function in the ASPI test and platelet count as secondary endpoints. Results:In 36 patients included in the main analysis, we found significant differences between the two study groups in the levels of ADP-induced platelet aggregation at days seven and 14 after cessation of clopidogrel (p = 0.004 and p = 0.04, respectively). In the abrupt group, platelet aggregation returned to the values similar to baseline at day seven. There were no significant differences between baseline, seven, and 14 days after drug cessation (p = 0.92 and p = 0.37, respectively). However, in the tapering group, ADP values at seven and 14 days after drug cessation were significantly decreased, comparing to baseline (p < 0.0001 and p = 0.009, respectively). For the ASPI test and platelet count we did not find significant differences between the groups. All values returned to levels similar to the baseline. During the follow-up there were no serious cardiovascular events or bleedings.Conclusions: Tapering vs. abrupt discontinuation of clopidogrel treatment results in significantly lower platelet aggregation values after 14 days from complete drug cessation. We found no evidence of a platelet rebound effect.

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Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study

Cited by 28 publications

References 40 publications

Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent

Patient-Centered Tablet Application for Improving Medication Adherence after a Drug-Eluting Stent

Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications

A single-centre, randomised study on platelet reactivity after abrupt or gradual discontinuation of long-term clopidogrel therapy in patients after percutaneous coronary intervention

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