Combination therapy with clopidogrel and aspirin after coronary stenting

Abstract

Combination antiplatelet therapy using aspirin and ticlopidine has been the standard of care for prevention of subacute thrombosis following coronary stent implantation. However, the use of ticlopidine is associated with a significant risk of adverse hematologic side effects. Clopidogrel is an inhibitor of ADP-induced platelet aggregation that has a better safety profile than ticlopidine. We examined the 30-day clinical outcome following coronary stent implantation in 253 consecutive patients treated with clopidogrel and aspirin. Follow-up was achieved in 99% of patients and four adverse events were documented. Two patients had angiographically confirmed subacute stent thrombosis (0.8%), and both of these patients underwent successful repeat angioplasty at the stent site. There were two patient deaths during follow-up (0. 8%). One was sudden within 1 week of stent placement and the other occurred in a patient with multisystem organ failure after an extensive myocardial infarction that antedated the stent procedure, with no clinical evidence for stent thrombosis. The combined frequency of subacute stent thrombosis and death was 1.6%. This is comparable to prior studies using the combination of ticlopidine and aspirin following stenting. Therefore, clopidogrel in combination with aspirin appears to be a safe and effective therapy in the prevention of subacute thrombosis following coronary stent implantation.

Case Report on Clopidogrel Rash After Coronary Placement of a Paclitaxol-Coated Stent

“…4 The importance of clopidogrel treatment after coronary stent implantation is well-established. 5,6 Clopidogrel can cause gastrointestinal complaints, hypersensitivity reactions, and rash. 3 The reported incidence of clopidogrel induced rash from CAPRIE trial is 0.26%.…”

Anaesthetic considerations in a parturient with critical coronary artery disease and a drug-eluting stent presenting for caesarean section

“…11,12 In addition, continuing this therapy for up to one year after stenting has been shown to give a 26.9% relative reduction in the combined risk of death, myocardial infarction or stroke when compared to short-term therapy. 13 All previous studies looking specifically at the Cyphere stent have used aspirin and clopidogrel in various dose regimes before and after stent placement.…”