Duration of Dual Antiplatelet Therapy and Long-Term Clinical Outcome After Coronary Drug-Eluting Stent Implantation

Abstract

on behalf of the CREDO-Kyoto PCI/ CABG Registry Cohort-2 Investigators Background-Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation has not been yet fully elucidated. Methods and Results-We assessed the influence of prolonged thienopyridine therapy on clinical outcomes with landmark analysis at 4 and 13 months after DES implantation. Among 6802 patients with at least 1 DES implantation in the CREDO-Kyoto Registry Cohort-2, 6309 patients (on thienopyridine, 5438 patients; off thienopyridine, 871 patients) and 5901 patients (on thienopyridine, 4098 patients; off thienopyridine, 1803 patients) were eligible for the 4-and 13-month landmark analyses, respectively. The majority of patients had stable coronary artery disease (73%) and received sirolimus-eluting stents (93%), and approximately 90% of thienopyridine was ticlopidine. Patients taking thienopyridine had more complex comorbidities and more complex lesion and procedural characteristics as compared with patients not taking thienopyridine. After adjusting for confounders, thienopyridine use was not associated with decreased risk for death/myocardial infarction/stroke (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.89 -1.43, Pϭ0.32 in the 4-month landmark analysis; HR, 1.14; 95% CI, 0.90 -1.45, Pϭ0.29 in the 13-month landmark analysis, respectively), whereas the risk for GUSTO moderate/severe bleeding tended to be higher in patients taking thienopyridine (HR, 1.51; 95% CI, 1.00 -2.23, Pϭ0.049 in the 4-month landmark analysis; HR, 1.44; 95% CI, 0.99 -2.09, Pϭ0.057 in the 13-month landmark analysis, respectively). Conclusions-Prolonged thienopyridine therapy beyond 4 and 13 months appeared not to be associated with reduction in ischemic events but to be associated with a trend toward increased bleeding. Optimal duration of DAPT after DES implantation might be shorter than the currently recommended 1-year interval. (Circ Cardiovasc Interv. 2012;5:381-391.)

Effects of Eicosapentaenoic Acid on Platelet Function in Patients Taking Long-Term Aspirin Following Coronary Stent Implantation

“…In fact, in the chronic phase, the risks of CAD or cerebrovascular disease are much higher than that of stent thrombosis. 3,4) Therefore, lifelong treatment with ASA is also recommended for the secondary prevention of atherothrombotic events following DAPT termination. 1,2) Eicosapentaenoic acid (EPA) has been widely accepted to have antiatherosclerotic effects.…”

“…Vol 55 No 3 EFFECTS OF EPA ON PLATELET FUNCTION AFTER PCI plantation. Exclusion criteria were as follows: age < 50 or > 75 years, familial hyperlipidemia, liver injury (AST ≥ 100 U/L, ALT ≥ 100U/L, γGTP ≥ 150U/L, ALP ≥ 300, total bilirubin ≥ 3), renal insufficiency (serum creatinine ≥ 2 mg/dL), recent bleeding episode, uncontrollable hypertension (systolic BP ≥ 180 mmHg or diastolic BP ≥ 110 mmHg), diabetes mellitus with HbA1c ≥ 10%, scheduled for surgery, use of nonsteroidal anti-inflammatory drugs, and previous treatment with antiplatelet therapy other than ASA within the past 30 days.…”

How to manage prasugrel and ticagrelor in daily practice

“…Irrespective of the indication, duration of dual antiplatelet therapy should not exceed 12 months, as it has not been proved that a longer period prevents ischaemic events beyond this period, and there remain concerns with the increased bleeding risk of dual antiplatelet therapy in stable cardiovascular patients [33][34][35][36].…”

Exploring a Laboratory Model of Pharmacogenetics as Applied to Clinical Decision Making

“…14,15 An excess of one million coronary artery stents are placed annually in the United States to prevent complications, including death, in patients with coronary artery disease. 16,17 Dual antiplatelet therapy is a standard of practice and clopidogrel is a common drug used in this setting. 17 Clopidogrel, a prodrug, requires bioactivation to form an active compound, which inhibits platelet aggregation by inhibiting adenosine diphosphate (ADP) binding to P2Y 12 receptors on platelets.…”

“…16,17 Dual antiplatelet therapy is a standard of practice and clopidogrel is a common drug used in this setting. 17 Clopidogrel, a prodrug, requires bioactivation to form an active compound, which inhibits platelet aggregation by inhibiting adenosine diphosphate (ADP) binding to P2Y 12 receptors on platelets. This effectively decreases platelet aggregation, helping to prevent thrombosis.…”