Reasonable Duration of Clopidogrel Use After Drug-Eluting Stent Implantation in Korean Patients

Shin, Dong Ho; Chae, In Ho; Youn, Tae Jin; Cho, Sung-Il; Kwon, Dong A.; Suh, Jung Won; Chang, Hyuk Jae; Cho, Young Seok; Chung, Woo Young; Choi, Young Jin; Gwon, Hyeon Cheol; Han, Kyoo Rok; Choi, Dong Ju

doi:10.1016/j.amjcard.2009.07.049

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…13, 14, 17 Their findings may have differed from ours for several reasons. First, Park’s study was derived from merged data of two separate trials in which there was an initial assumption of a 50% relative risk reduction in cardiac death and MI and an expected 5% event rate.…”

Section: Discussioncontrasting

confidence: 78%

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

Mulukutla

Marroquin

Vlachos

et al. 2013

The American Journal of Cardiology

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The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is an important, unanswered question. This study was designed to evaluate the association of varying durations of DAPT on clinical outcomes after DES implantation for the treatment of coronary artery disease. Using the National Heart, Lung and Blood Institute (NHLBI) Dynamic Registry, patients enrolled in the last two waves after index percutaneous coronary intervention (PCI) with DES and who were event free at time of landmark analysis were included. Landmark analysis was performed at 12 and 24 months after PCI and patients stratified according to continued use of DAPT or not. Subjects were evaluated for rates of death, myocardial infarction (MI) and stent thrombosis (ST) at 4 years from their index procedure. The number of evaluable patients was 2157 and 1918 for the 12- and 24-month landmarks, respectively. In both landmark analyses, there was a significantly lower 4-year rate of death/MI in the group that continued DAPT compared to the group that did not (12-month: 10.5% vs. 14.5%, p=0.01; 24-month: 5.7% vs. 8.6%, p=0.02). Beneficial differences in the group that continued on DAPT were preserved after multivariate and propensity adjustment. There were no significant differences in definite stent thrombosis in either landmark analysis. In conclusion, at 12-months and 24-months following DES implantation, continued use of DAPT, was associated with lower 4-year risk of death and myocardial infarction.

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Section: Discussioncontrasting

confidence: 78%

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

Mulukutla

Marroquin

Vlachos

et al. 2013

The American Journal of Cardiology

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“…Discontinuation within the first year, particularly within the first month, has been associated with adverse events [21]. Based on a landmark approach, 3 studies evaluating event-free patients after 4-6-months of follow-up found that continued use of P2Y12 antagonists did not reduce the risk of adverse events [22,27,28], while 2 other studies showed that it reduced the risk [21,29]. Regional differences, particularly socio-economic factors affecting compliance, may explain this discrepancy in part.…”

Section: Discussionmentioning

confidence: 99%

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

Thim

Johansen

Chisholm

et al. 2014

BMC Cardiovasc Disord

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BackgroundThe impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available.MethodsWe followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases.ResultsDiscontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation.ConclusionsDiscontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.

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“…Two propensity analyses have recently addressed this issue 1 4. The study by Harjai et al 1 analysed 835 patients treated with bare metal stents and 1024 treated with drug-eluting stents, while Shin et al 4 examined fewer patients (N=844) treated with drug eluting stents (with the advantage that a matched-pair analysis was tried).…”

mentioning

confidence: 99%

“…The study by Harjai et al 1 analysed 835 patients treated with bare metal stents and 1024 treated with drug-eluting stents, while Shin et al 4 examined fewer patients (N=844) treated with drug eluting stents (with the advantage that a matched-pair analysis was tried). Both studies suggest that prolonging clopidogrel beyond 6 or 12 months confers no benefit.…”

mentioning

confidence: 99%

Long-term dual antiplatelet therapy after percutaneous coronary intervention

Messori¹,

Fadda²,

Trippoli³

2010

Heart

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Reasonable Duration of Clopidogrel Use After Drug-Eluting Stent Implantation in Korean Patients

Cited by 11 publications

References 28 publications

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

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

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

Long-term dual antiplatelet therapy after percutaneous coronary intervention

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