| Adverse events after stopping clopidogrel in post-acute coronary syndrome patients: Insights from a large integrated healthcare delivery system. | |
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MedLine Citation:
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PMID: 20354221 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: A prior study from the Veterans Health Administration found a clustering of cardiovascular events after clopidogrel cessation. We sought to confirm and expand these findings. METHODS AND RESULTS: This was a retrospective cohort study of 2017 patients with acute coronary syndrome discharged on clopidogrel from an integrated health care delivery system. Rates of all-cause mortality or acute myocardial infarction (MI) within 1 year after stopping clopidogrel were assessed among patients who did not have an event before stopping clopidogrel. Death/MI occurred in 4.3% (n=71) of patients. The rates of death/MI were 3.07, 1.62, 0.70, and 0.95 per 10 000 patient-days for the time intervals of 0 to 90, 91 to 180, 181 to 270, and 271 to 360 days after stopping clopidogrel. In multivariable analysis, the 0- to 90-day interval after stopping clopidogrel was associated with higher risk of death/MI (incidence rate ratio, 2.74; 95% confidence interval, 1.69 to 4.44) compared with 91- to 360-day interval. There was a similar trend of increased events after stopping clopidogrel for various subgroups (women versus men, medical therapy versus percutaneous coronary intervention, stent type, and > or =6 months or <6 months of clopidogrel treatment). Among patients taking clopidogrel but stopping ACE inhibitor medications, the event rates were similar in the 0- to 90-day versus the 91- to 360-day interval (2.67 versus 2.91 per 10 000 patient-days; P=0.91). CONCLUSIONS: We observed a clustering of adverse events in the 0 to 90 days after stopping clopidogrel. This clustering of events was not present among patients stopping ACE inhibitors. These findings are consistent with a possible rebound platelet hyper-reactivity after stopping clopidogrel and additional platelet studies are needed to confirm this effect. |
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Authors:
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P Michael Ho; Thomas T Tsai; Tracy Y Wang; Susan M Shetterly; Christina L Clarke; Alan S Go; Art Sedrakyan; John S Rumsfeld; Eric D Peterson; David J Magid |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S. Date: 2010-03-30 |
Journal Detail:
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Title: Circulation. Cardiovascular quality and outcomes Volume: 3 ISSN: 1941-7705 ISO Abbreviation: Circ Cardiovasc Qual Outcomes Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-20 Completed Date: 2010-09-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101489148 Medline TA: Circ Cardiovasc Qual Outcomes Country: United States |
Other Details:
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Languages: eng Pagination: 303-8 Citation Subset: IM |
Affiliation:
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Denver VA Medical Center, CO, USA. michael.ho@coloradooutcomes.org <michael.ho@coloradooutcomes.org> |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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complications,
drug therapy*,
epidemiology*,
mortality Aged Aged, 80 and over Angiotensin-Converting Enzyme Inhibitors / therapeutic use Delivery of Health Care, Integrated Female Humans Male Middle Aged Myocardial Infarction / epidemiology*, etiology, mortality, prevention & control* Patient Discharge Platelet Aggregation Inhibitors / therapeutic use* Retrospective Studies Risk Factors Survival Analysis Ticlopidine / analogs & derivatives*, therapeutic use United States Withholding Treatment |
| Grant Support | |
ID/Acronym/Agency:
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290-05-0033//PHS HHS; U19 HL091179/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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