Prolonged Dual Antiplatelet Therapy Improves Clinical Outcomes in High‐risk Patients Implanted with Sirolimus‐eluting Stents

Abstract

BackgroundAlthough a science advisory recommending 12 months of dual antiplatelet therapy after drug‐eluting stents implantation was published recently, the optimal duration of dual antiplatelet therapy has not yet been precisely determined.HypothesisProlonged dual antiplatelet therapy can improve clinical outcomes in high‐risk patients implanted with sirolimus‐eluting stents.MethodsThe patients implanted with sirolimus‐eluting stents were assigned into standard clopidogrel therapy group (clopidogrel 75 mg/d for 12 mo) and prolonged clopidogrel therapy group (clopidogrel 75 mg/d for 18 mo). Long‐term aspirin (100 mg/d) therapy was adopted in both groups. The primary endpoint was very late stent thrombosis.ResultsAfter 12 months, 24 patients were excluded because of major adverse cardiovascular events (MACEs). Three hundred and thirty six patients surviving without MACEs were further followed up for 6 months. Between 12 and 18 months, in 160 patients with standard clopidogrel therapy, 5.6% had very late stent thrombosis. In contrast, in 176 patients with prolonged clopidogrel therapy, 1.1% had very late stent thrombosis (p < 0.01, versus standard clopidogrel therapy group).ConclusionsProlonged dual antiplatelet therapy may be beneficial to prevent very late stent thrombosis after sirolimus‐eluting stents implantation in high‐risk patients. Copyright © 2009 Wiley Periodicals, Inc.

Differential Effects of Esomeprazole on the Antiplatelet Activity of Clopidogrel in Healthy Individuals and Patients after Coronary Stent Implantation

“…7 Although the advised duration of dual antiplatelet regimens is 12 months, the optimum duration is controversial. 8,9 For example, long-term (> 4 weeks) dual antiplatelet therapy with clopidogrel and aspirin after percutaneous coronary intervention (PCI) was found to be associated with an increased incidence of gastrointestinal complications and, although not associated with a significant increase in the overall incidence of bleeding events, there was an increase in major gastrointestinal bleeding in the year after a PCI. 10 A higher dose of clopidogrel for a period of 12 months after implantation of a drug-eluting stent was found to be associated with a greater risk of subsequent bleeding events.…”

Risk of Long‐Term Dual Antiplatelet Therapy Following Drug‐Eluting Stent Implantation in Octogenarians

“…There are 2 possible explanations for the increased incidence of bleeding events observed in the present study. First, as mentioned above, older age is a significant predictor of bleeding . The current study included only patients aged ≥80 years, which could have contributed to the higher incidence of bleeding events relative to those reported by previous investigators.…”

“…Long‐term DAT is required to prevent stent thrombosis following DES implantation . However, DAT is associated with the potential risk of bleeding events, particularly in octogenarians.…”

“…[6][7][8][9] Among octogenarians, however, limited information is available regarding the incidence of bleeding events during DAT, and the safety of long-term DAT in this population has not yet been guaranteed. Since older age is a strong predictor of bleeding, 6,7,[10][11][12][13][14][15][16] we hypothesized that long-term DAT following DES implantation might be associated with an increased risk of bleeding events in octogenarians. Accordingly, we compared the long-term clinical outcomes of DES and BMS implantation in octogenarians who underwent DAT.…”

Beneficial Impact of Prolonged Dual Antiplatelet Therapy after Drug‐Eluting Stent Implantation

“…A total of 34 studies were identified, including 7 randomized trials (with 2 ongoing) and 1 meta‐analysis, thus leaving 26 nonrandomized controlled studies (Table 5). 16,19–20,23–50 A total of 208,670 patients were included, and 28,345 will be enrolled in currently ongoing studies. Clinical trials were not unanimously in favor or against DAT beyond 6–12 months.…”