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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

Coronary artery stenting in patients treated by clopidogrel without aspirin

David Rott, David Leibowitz, Guy Amit

    International Journal of Cardiology
    |January 8, 2008
    PubMed

    Insights

    Clopidogrel monotherapy after coronary stenting showed a high rate of stent thrombosis. Patients unable to tolerate aspirin may need alternative anti-platelet strategies or consider percutaneous transluminal coronary angioplasty (PTCA) alone.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Pharmacology

    Background:

    • Standard treatment for coronary stenting involves dual anti-platelet therapy with aspirin and clopidogrel.
    • The safety and efficacy of clopidogrel monotherapy in aspirin-intolerant patients undergoing stenting remain unclear.
    • Major adverse clinical events (MACE) risk in this population requires thorough investigation.

    Discussion:

    • This study assessed MACE risk in patients treated with clopidogrel only after bare metal coronary stenting.
    • The review included 43 patients with at least 1-year follow-up, analyzing stent thrombosis, myocardial infarction (MI), death, and repeat percutaneous coronary intervention (PCI).
    • Findings indicate a significant risk of subacute stent thrombosis with clopidogrel monotherapy.

    Key Insights:

    • Two patients (4.7%) experienced acute MI within 30 days post-stenting.
    • Stent thrombosis was confirmed, necessitating target vessel revascularization.
    • Clopidogrel monotherapy is associated with a relatively high incidence of subacute stent thrombosis.

    Outlook:

    • Higher rates of stent thrombosis may occur with drug-eluting stents compared to bare metal stents.
    • Consideration of more potent anti-platelet regimens is warranted for aspirin-intolerant patients.
    • Percutaneous transluminal coronary angioplasty (PTCA) alone might be a safer alternative to stenting in select aspirin-intolerant individuals.
    Abstract

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