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Observational Study
. 2014 Aug 13:14:100.
doi: 10.1186/1471-2261-14-100.

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

Troels Thim, Martin Berg Johansen, Gro Egholm Chisholm, Morten Schmidt, Anne Kaltoft, Henrik Toft Sørensen, Leif Thuesen, Steen Dalby Kristensen, Hans Erik Bøtker, Lars Romer Krusell, Jens Flensted Lassen, Per Thayssen, Lisette Okkels Jensen, Hans-Henrik Tilsted, Michael Maeng  1
Affiliations
Observational Study

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

Troels Thim et al. BMC Cardiovasc Disord. .

Abstract

Background: The 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.

Methods: We 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.

Results: Discontinuation 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.

Conclusions: Discontinuation 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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Figures

Figure 1
Figure 1
Proportion of patients covered by a prescription for clopidogrel on each day during follow up.
Figure 2
Figure 2
Cumulative incidence of major adverse cardiac events (MACE). MACE is a composite of cardiac death, myocardial infarction, and definite stent thrombosis.
Figure 3
Figure 3
Cumulative incidence of major adverse cardiac events (MACE) following discontinuation of clopidogrel. MACE is a composite of cardiac death, myocardial infarction, and definite stent thrombosis.
See this image and copyright information in PMC

References

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