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- Title
High risk of stent thrombosis in the first 6 months after coronary stenting: Do not discontinue clopidogrel early after ACS.
- Authors
Zwart, Bastiaan; Godschalk, Thea C.; Kelder, Johannes C.; ten Berg, Jurriën M.
- Abstract
<bold>Objectives: </bold>To estimate the incidence of stent thrombosis (ST) after early discontinuation of clopidogrel.<bold>Background: </bold>Premature discontinuation of clopidogrel is the strongest risk factor for ST. In contrast, recent studies suggest that shorter dual antiplatelet therapy (DAPT) can be discontinued as soon as 3 months after stenting. However, these studies included very few ACS patients and were not powered for ST. Hence, little is known about the occurrence of ST in high-risk populations when DAPT is discontinued early.<bold>Methods: </bold>This is a subanalysis of The Dutch ST Registry 437 ST cases (mainly first-generation DES and BMS). Acute coronary syndrome was the indication for index-PCI in 74% of the patients. Clopidogrel discontinuation rates in ST patients and matched controls were used to calculate the absolute incidence of ST after early clopidogrel discontinuation.<bold>Results: </bold>The overall rate of ST after cessation of clopidogrel was 4.6% (95%CI: 3.9-5.4%), as compared to 1.7% (95%CI: 1.5-1.9%) in patients who did not discontinue clopidogrel. The incidence of ST was 35.4% when clopidogrel was discontinued in the first 30 days after index-PCI declining to 11.7% when clopidogrel was discontinued in the first 180 days.<bold>Conclusions: </bold>This dedicated ST registry shows that ST rates were very high when clopidogrel was discontinued before 6 months after index-PCI and therefore suggests that clopidogrel discontinuation in the first 6 months after ACS should be avoided.
- Subjects
NETHERLANDS; THROMBOSIS; PLATELET aggregation inhibitors; ASPIRIN; ACUTE coronary syndrome; TREATMENT of acute coronary syndrome; CARDIOVASCULAR system; DRUG administration; MEDICAL care; SURGICAL stents; SURGICAL complications; TICLOPIDINE; VASCULAR grafts; DISEASE incidence; ACQUISITION of data; THERAPEUTICS
- Publication
Journal of Interventional Cardiology, 2017, Vol 30, Issue 5, p421
- ISSN
0896-4327
- Publication type
journal article
- DOI
10.1111/joic.12413