Duration of dual antiplatelet therapy after drug eluting stents

January 01, 0001

Duration of dual antiplatelet therapy after drug eluting stents

These Korean investigators conducted two trials of antiplatelet therapy following placement of drug eluting stents. They randomly assigned a total of 2701 patients who had received drug-eluting stents and had been free of major adverse cardiac or cerebrovascular events and major bleeding for a period of at least 12 months to receive clopidogrel plus aspirin or aspirin alone. The primary end point was a composite of myocardial infarction or death from cardiac causes. Data from the two trials were merged for analysis.

They found: "The median duration of follow-up was 19.2 months. The cumulative risk of the primary outcome at 2 years was 1.8% with dual antiplatelet therapy, as compared with 1.2% with aspirin monotherapy (hazard ratio 1.65, NS). The individual risks of myocardial infarction, stroke, stent thrombosis, need for repeat revascularization, major bleeding, and death from any cause did not differ significantly between the two groups. However, in the dual-therapy group as compared with the aspirin-alone group, there was a nonsignificant increase in the composite risk of myocardial infarction, stroke, or death from any cause (hazard ratio 1.73) and in the composite risk of myocardial infarction, stroke, or death from cardiac causes (hazard ratio 1.84)."

The authors concluded: "The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received drug-eluting stents was not significantly more effective than aspirin monotherapy in reducing the rate of myocardial infarction or death from cardiac causes. These findings should be confirmed or refuted through larger, randomized clinical trials with longer-term follow-up."

The default should be aspirin monotherapy after 12 months because it is lower in cost and the nonsignificant trends were against dual therapy. First do no harm.

For the full abstract, click here.

N Engl J Med 362(15):1374-1382, 15 April 2010
© 2010 to the Massachusetts Medical Society
Duration of Dual Antiplatelet Therapy after Implantation of Drug-Eluting Stents. Seung-Jung Park, Duk-Woo Park, Young-Hak Kim, et al. Correspondence to Dr. S J Park: [email protected]

Category: K. Circulatory. Keywords: drug-eluting stents, aspirin, clopidogrel, myocardial infarction, cardiac events, stroke, stent thrombosis, bleeding, death, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 4 May don't fill in 2010

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