Related Experiment Video
Updated: Jun 24, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Prolonged dual antiplatelet therapy improves clinical outcomes in high-risk patients implanted with sirolimus-eluting
Jia Dean1, Zhou Yujie, Zhao Yingxin
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Prolonging dual antiplatelet therapy to 18 months after sirolimus-eluting stent implantation significantly reduced very late stent thrombosis in high-risk patients. This extended duration offers improved clinical outcomes compared to standard 12-month therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The optimal duration of dual antiplatelet therapy (DAPT) post-drug-eluting stent implantation remains under investigation, despite recent guidelines.
- High-risk patients may benefit from extended DAPT durations.
Purpose of the Study:
- To evaluate the efficacy of prolonged DAPT (18 months) versus standard DAPT (12 months) in preventing very late stent thrombosis after sirolimus-eluting stent implantation.
- To assess clinical outcomes in high-risk patients undergoing sirolimus-eluting stent procedures.
Main Methods:
- A randomized trial comparing 12-month DAPT (aspirin + clopidogrel) versus 18-month DAPT (aspirin + clopidogrel) in patients with sirolimus-eluting stents.
- The primary endpoint was very late stent thrombosis, assessed over an 18-month follow-up period.
Main Results:
- Among 336 patients without major adverse cardiovascular events at 12 months, 160 received standard DAPT and 176 received prolonged DAPT.
- Very late stent thrombosis occurred in 5.6% of patients on standard DAPT versus 1.1% on prolonged DAPT (p<0.01) between 12 and 18 months.
Conclusions:
- Extended DAPT duration to 18 months significantly reduces the risk of very late stent thrombosis in high-risk patients treated with sirolimus-eluting stents.
- Prolonged DAPT appears to be a beneficial strategy for improving long-term outcomes in this patient population.
Background:
Although a science advisory recommending 12 months of dual antiplatelet therapy after drug-eluting stents implantation was published recently, the optimal duration of dual antiplatelet therapy has not yet been precisely determined.
Hypothesis:
Prolonged dual antiplatelet therapy can improve clinical outcomes in high-risk patients implanted with sirolimus-eluting stents.
Methods:
The patients implanted with sirolimus-eluting stents were assigned into standard clopidogrel therapy group (clopidogrel 75 mg/d for 12 mo) and prolonged clopidogrel therapy group (clopidogrel 75 mg/d for 18 mo). Long-term aspirin (100 mg/d) therapy was adopted in both groups. The primary endpoint was very late stent thrombosis.
Results:
After 12 months, 24 patients were excluded because of major adverse cardiovascular events (MACEs). Three hundred and thirty six patients surviving without MACEs were further followed up for 6 months. Between 12 and 18 months, in 160 patients with standard clopidogrel therapy, 5.6% had very late stent thrombosis. In contrast, in 176 patients with prolonged clopidogrel therapy, 1.1% had very late stent thrombosis (p<0.01, versus standard clopidogrel therapy group).
Conclusions:
Prolonged dual antiplatelet therapy may be beneficial to prevent very late stent thrombosis after sirolimus-eluting stents implantation in high-risk patients.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:27Peripheral Artery Disease III: Interprofessional Care
01:27Coronary Artery Disease V: Interprofessional Care