Extended Use of Dual Antiplatelet Therapy Not Effective
- Tue, 3/16/10 - 11:07am
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Dual antiplatelet therapy no more effective than aspirin-only therapy for long-term treatment
ACC 2010, Atlanta, Georgia. Coronary patients should not continue dual antiplatelet therapy 1 year after receiving a drug-eluting stent, according to research presented at the American College of Cardiology’s 59th annual scientific session.
The optimal duration of dual antiplatelet therapy administration following drug-eluting stent implantation had not previously been determined.
For this study, patients either continued to receive clopidogrel 12 months after drug-eluting stent implantation or discontinued the medication. A total of 2,701 patients, who had had no major complications in the year since receiving drug-eluting stents, were randomized to the clopidogrel discontinuation group (1,344 patients) or the clopidogrel continuation group (1,357 patients).
During a follow-up period which had a median of 19.2 months, the cumulative risk of the primary outcome (a composite measure of cardiac death and heart attack) at two years was 1.8 percent with dual antiplatelet therapy versus 1.2 percent with aspirin-only therapy.
The individual risks of death, myocardial infarction, stroke, stent thrombosis, repeat revascularization or major bleeding were not different between the two groups. However, in the group that received dual antiplatelet therapy, there was a nonsignificant increase in the composite risk of death, heart attack or stroke and in the composite risk of cardiac death, heart attack or stroke.
“Extended use of dual antiplatelet therapy beyond 12 months among patients who received drug-eluting stents was not significantly more effective than aspirin-only therapy in reducing the rate of cardiac death or heart attack,” said Dr. Seung-Jung Park, of the Asan Medical Center, Seoul, South Korea and the study’s lead researcher. “These findings provide a key direction for the future of post-drug-eluting stent treatment.”
Despite the findings, Dr. Park did caution that these findings should be confirmed or refuted through larger, randomized clinical trials with longer-term follow-up.
Dr. Park reports no disclosures.
