Quitting Antiplatelets Early After Stents Tied to CV Risk
Greater risk of stent thrombosis and death when oral antiplatelet therapy ends early
THURSDAY, Jan. 20 (HealthDay News) -- Early discontinuation of antiplatelet therapy in patients following drug-eluting stent implantation is associated with an increased risk of cardiovascular events, including stent thrombosis and death, according to a study published in the Jan. 15 issue of The American Journal of Cardiology.
Roberta Rossini, M.D., Ph.D., from the Ospedali Riuniti di Bergamo in Italy, and colleagues studied 1,358 patients who were treated with drug-eluting stents and discharged with dual oral antiplatelet therapy. These patients were kept on aspirin for the rest of their lives and were prescribed clopidogrel for 12 months. The researchers followed these patients for 36 months to determine the prevalence and predictors of premature discontinuation of oral antiplatelet therapy after drug-eluting stent implantation.
The researchers found that 8.8 percent of patients discontinued one or both antiplatelet agents within the first 12 months (considered early), and 4.8 percent discontinued aspirin after one year. Predictors of early discontinuation were major bleeding in the hospital, use of oral anticoagulants at the time of discharge, and the lack of a statin prescription. Patients with early discontinuation were found to experience significantly higher incidences of major adverse cardiac events and stent thrombosis. All-cause mortality and cardiovascular death were also found to be much more frequent among early discontinuation patients. Stopping aspirin after the first year was not significantly associated with cardiac events or stent thrombosis.
"In our study, premature discontinuation of antiplatelet therapy was associated with a poor prognosis, which was more evident if it occurred within the first year after stent implantation," the authors write.
Several authors disclosed financial ties with pharmaceutical and medical device corporations.