Twelve or 30 Months of Dual Antiplatelet Therapy After Drug-eluting Stents

By L. Mauri, D. Kereiakes, Robert W. Yeh, P. Driscoll-Shempp, D. Cutlip, P. Steg, Sharon-Lise T. Normand, E. Braunwald, S. Wiviott, David J. Cohen and 12 more. New England Journal of Medicine, 2014

1,768 citations recorded by the source corpus.

Background Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain. Methods Subjects were enrolled after a drug-eluting coronary stent procedure. After 12 months of thienopyridine (clopidogrel bisulfate [Plavix] or prasugrel [Effient/Efient]) with aspirin, subjects were randomized to continued thienopyridine or placebo for another 18 months; all continued aspirin. The co-primary effectiveness end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial infarction, or stroke) at 12 to 30 months. The primary safety end point was moderate or severe bleeding. Results Subjects (N=9,961) were randomized to continued thienopyridine or placebo. Continued thienopyridine reduced stent thrombosis (0.4% vs. 1.4%, hazard ratio 0.29, 95% confidence interval [CI] 0.17-0.48, P<0.001) and major adverse cardiovascular and cerebrovascular events (4.3% vs. 5.9%, hazard ratio 0.71, 95% CI 0.59-0.85, P<0.001). Myocardial infarction was reduced (2.1% vs. 4.1%, hazard ratio 0.47, P<0.001). Rates of all-cause mortality in the continued thienopyridine and placebo groups were 2.0 and 1.5%, respectively (hazard ratio 1.36, 95% CI 1.00-1.85, P=0.052). Moderate or severe bleeding was increased with continued thienopyridine (2.5% vs. 1.6%, P=0.001). An elevated hazard for stent thrombosis and myocardial infarction was observed in both groups during the 3 months following thienopyridine discontinuation. Conclusion Dual antiplatelet therapy beyond one year after drug-eluting stent placement significantly reduced the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events compared with aspirin alone, but was associated with increased bleeding.

Subfields: Cardiology and Cardiovascular Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/2fe575573f44bd6c409ccf2dbcd63a273e3b233f

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Cardiology and Cardiovascular Medicine

Citations in the corpus

The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. (2018, background): “Current ACS guidelines recommend DAPT for up to 1 year after the acute event in patients without indication for OAC, while high-risk patients might require an even longer DAPT duration.(318,319) They do, however, also allow for shorter DAPT durations (3–6 months) in high bleeding risk ACS patients.”
2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2016, background): “, sirolimus- and paclitaxel-eluting) DES, which are rarely, if ever, used in current clinical practice (16,36,38).”
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2016, background): “, sirolimus- and paclitaxel-eluting) DES, which are rarely, if ever, used in current clinical practice (16,36,38).”
Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention. (2016, methodology): “Two forms of validation were conducted: (1) evaluation of the DAPT Study–derived ischemic and bleeding models and (2) evaluation of prediction score performance in stratifying risks of ischemic and bleeding events.”