Document Detail


Prolonged Clopidogrel Use After Bare Metal and Drug-Eluting Stent Placement: The Veterans Administration Drug-Eluting Stent Study.
MedLine Citation:
PMID:  22668555     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Current guidelines recommend combining clopidogrel with aspirin for up to 1 year after coronary stenting, but the value of clopidogrel beyond this time is uncertain. METHODS AND RESULTS: We evaluated all patients in the Veterans Administration healthcare system receiving either drug-eluting or bare metal stents from 2002 to 2006. The Veterans Administration National Patient Care and Pharmacy databases were used to extract patient characteristics, duration of clopidogrel use, and outcomes for up to 4 years after the index procedure. We used Cox proportional hazards to estimate hazard ratios for death, myocardial infarction, revascularization, and bleeding from a 12-month landmark after stenting that excluded patients with events within the first 12 months. Of 42 254 patients, 29 175 met the study inclusion criteria. Compared with ≤12 months of clopidogrel, prolonged clopidogrel (>12 months) was associated with a lower adjusted risk of death for both drug-eluting stents (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.61, 0.82; P<0.01) and bare metal stents (HR, 0.85; 95% CI, 0.76, 0.96; P=0.01) as well as for death and myocardial infarction but was unrelated to stroke or major bleeding. The effect of prolonged clopidogrel on death or myocardial infarction was significantly greater among patients receiving drug-eluting (HR, 0.70; 95% CI, 0.64, 0.84) compared with bare metal stents (HR, 0.88; 95% CI, 0.79, 0.98; interaction P=0.024). CONCLUSIONS: Patients receiving clopidogrel beyond 12 months had a lower risk of death or myocardial infarction compared patients receiving clopidogrel ≤12 months. The risk reduction was greater for drug-eluting stents. These data support longer durations of dual antiplatelet therapy for patients receiving a stent, particularly for those receiving a drug-eluting stent.
Authors:
David Faxon; Elizabeth Lawler; Melissa Young; Michael Gaziano; Scott Kinlay
Related Documents :
7995265 - Beta-blockers in cardiac failure.
227935 - Beta adrenergic and muscarinic cholinergic receptors in canine myocardium. effects of i...
21721425 - Fractional flow reserve guided coronary revascularization in drug-eluting era in thai p...
21241235 - Is there evidence to support the use of direct factor xa inhibitors in coronary artery ...
7514505 - Lp(a): an acute-phase reactant?
10953265 - Management of atrial flutter.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-5
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, MA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Stent thrombosis with everolimus-eluting stents: meta-analysis of comparative randomized controlled ...
Next Document:  Predictors and Prognostic Value of Myocardial Injury During Transcatheter Aortic Valve Implantation.