Document Detail


Adverse events after stopping clopidogrel in post-acute coronary syndrome patients: Insights from a large integrated healthcare delivery system.
MedLine Citation:
PMID:  20354221     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
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:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  3     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-09-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  303-8     Citation Subset:  IM    
Affiliation:
Denver VA Medical Center, CO, USA. michael.ho@coloradooutcomes.org <michael.ho@coloradooutcomes.org>
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / 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:
290-05-0033//PHS HHS; U19 HL091179/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
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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