Prevalence, Predictors, and Long-Term Prognosis of Premature Discontinuation of Oral Antiplatelet Therapy After Drug Eluting Stent Implantation - 06/08/11
, Davide Capodanno, MD b, Corrado Lettieri, MD c, Giuseppe Musumeci, MD a, Tamar Nijaradze, MD a, Michele Romano, MD c, Nikoloz Lortkipanidze, MD a, Nicola Cicorella, MD c, Giuseppe Biondi Zoccai, MD d, Vasile Sirbu, MD a, Antonio Izzo, MD c, Giulio Guagliumi, MD a, Orazio Valsecchi, MD a, Antonello Gavazzi, MD a, Dominick J. Angiolillo, MD, PhD b
Corresponding author: Tel: (+39) 035-26-6455; fax: (+39) 035-40-0491Riassunto |
To date, limited information is available on the long-term discontinuation rates of antiplatelet therapy after drug-eluting stent implantation. The aim of the present study was to determine the prevalence and predictors of premature discontinuation of oral antiplatelet therapy after drug-eluting stent implantation and to evaluate its effects on long-term prognosis. We studied 1,358 consecutive patients successfully treated with drug-eluting stents and discharged with dual oral antiplatelet therapy. Aspirin was to be maintained lifelong, and clopidogrel was prescribed for 12 months. The patients were followed for 36 months. The prevalence and predictors of aspirin and clopidogrel discontinuation were assessed. Major adverse cardiac events, defined as death, myocardial infarction, destabilizing symptoms leading to hospitalization, and nonfatal stroke, were recorded. Definite, probable, and possible stent thrombosis (ST) and major and minor bleeding were also determined. Of the 1,358 patients, 8.8% had discontinued one or both antiplatelet agents within the first 12 months (“early” discontinuation) and 4.8% had discontinued aspirin after 1 year (“late” discontinuation). Early discontinuation was predicted by in-hospital major bleeding, the use of oral anticoagulants at discharge, and the lack of a statin prescription. Previous stroke was the only independent predictor of late discontinuation. Patients with early discontinuation experienced a greater incidence of major adverse cardiac events (28.6% vs 13.7%, p <0.001) and ST (7.6% vs 3.4%, p = 0.038). All-cause mortality (13.4% vs 4.7%, p <0.001) and cardiovascular death (5% vs 1.2%, p = 0.007) were significantly more frequent among patients with early discontinuation. In patients with late discontinuation, a nonstatistically significant increase was seen in major adverse cardiac events (20% vs 13.3%, p = 0.128) and ST (6.2% vs 3.2%, p = 0.275). In conclusion, premature discontinuation of antiplatelet therapy is relatively common, especially within the first year, and strongly associated with increased cardiovascular events, including ST and death.
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| Dr. Angiolillo has received honoraria for lectures from Bristol-Myers Squibb, New York, New York, Sanofi-Aventis, Bridgewater, New Jersey, Eli Lilly, Co., Indianapolis, Indiana, and Daiichi Sankyo, Inc., Parsippany, New Jersey; consulting fees from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, Co., Daiichi Sankyo, Inc., the Medicines Company, Parsippany, New Jersey, Portola, San Francisco, California, Novartis, East Hanover, New Jersey, Medicure, Winnipeg, Manitoba, Cananda, Accumetrics, San Diego, California, Arena Pharmaceuticals, San Diego, California, and AstraZeneca, London, United Kingdom; and research grants from GlaxoSmithKline, Brentford, London, United Kingdom, Otsuka, Tokyo, Japan, Eli Lilly, Co., Daiichi Sankyo, Inc., the Medicines Company, Portola, Accumetrics, Schering-Plough Kenilworth, New Jersey, AstraZeneca, Eisai, Woodcliff Lake, New Jersey, and Johnson & Johnson, New Brunswick, New Jersey. Dr. Guagliumi has received consulting fees from Boston Scientific, Natick, Massachusetts and Volcano, San Diego, California and grant support from LightLab, Westford, Massachusetts, Medtronic Vascular, Minneapolis, Minnesota, Boston Scientific, and Abbott Vascular, Abbott Park, Illinois. |
Vol 107 - N° 2
P. 186-194 - gennaio 2011 Ritorno al numero
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