Prolonged clopidogrel use after bare metal and drug-eluting stent placement: the Veterans Administration drug-eluting

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David P Faxon1, Elizabeth Lawler, Melissa Young

  • 1Cardiovascular Division, Veterans Affairs Boston Healthcare System, Boston, MA, USA. dfaxon@partners.org

Circulation. Cardiovascular Interventions
|June 7, 2012
PubMed

Insights

Extended use of clopidogrel (a blood thinner) after coronary stenting significantly lowers the risk of death and heart attack. This benefit is more pronounced for patients with drug-eluting stents, supporting longer dual antiplatelet therapy durations.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Current guidelines suggest dual antiplatelet therapy (DAPT) with clopidogrel and aspirin for up to one year post-coronary stenting.
  • The long-term benefits of clopidogrel use beyond one year remain uncertain.

Purpose of the Study:

  • To evaluate the impact of prolonged clopidogrel use on patient outcomes after coronary stenting.
  • To compare the effectiveness of extended clopidogrel therapy in patients with drug-eluting stents versus bare metal stents.

Main Methods:

  • Retrospective analysis of patients receiving drug-eluting or bare metal stents from 2002-2006 within the Veterans Administration healthcare system.
  • Utilized Veterans Administration databases to extract patient characteristics, clopidogrel duration, and outcomes up to 4 years post-procedure.
  • Employed Cox proportional hazards models to assess risks of death, myocardial infarction, revascularization, and bleeding from a 12-month landmark.

Main Results:

  • Prolonged clopidogrel use (>12 months) was associated with a significantly lower adjusted risk of death for both drug-eluting stents (HR 0.70) and bare metal stents (HR 0.85).
  • Extended clopidogrel therapy also reduced the combined risk of death and myocardial infarction, with no increased risk of stroke or major bleeding.
  • The risk reduction for death or myocardial infarction was significantly greater in patients with drug-eluting stents compared to bare metal stents (interaction P=0.024).

Conclusions:

  • Patients treated with clopidogrel beyond 12 months experienced a reduced risk of death or myocardial infarction compared to those on shorter durations.
  • The benefit of prolonged clopidogrel therapy was more substantial for individuals with drug-eluting stents.
  • These findings support the use of longer durations of dual antiplatelet therapy, particularly for patients receiving drug-eluting stents.
Abstract

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