Discontinuation of both thienopyridine and aspirin, but not thienopyridine alone, was associated with an increased risk of stent thrombosis compared to continuing both (1.76% vs 0.1% at 31-180 days, P<0.001).
Observational (n=10,778)
Does discontinuation of antiplatelet therapy increase the risk of stent thrombosis and adverse clinical outcomes in patients after sirolimus-eluting stent implantation?
Discontinuation of both thienopyridine and aspirin, but not thienopyridine alone, is associated with an increased risk of stent thrombosis after sirolimus-eluting stent implantation.
Absolute Event Rate: 1.76% vs 0.1%
p-value: p=<0.001
BACKGROUND: The influences of antiplatelet therapy discontinuation on the risk of stent thrombosis and long-term clinical outcomes after drug-eluting stent implantation have not yet been addressed adequately. METHODS AND RESULTS: In an observational study in Japan, 2-year outcomes were assessed in 10 778 patients undergoing sirolimus-eluting stent implantation. Data on status of antiplatelet therapy during follow-up were collected prospectively. Incidences of definite stent thrombosis were 0.34% at 30 days, 0.54% at 1 year, and 0.77% at 2 years. Thienopyridine use was maintained in 97%, 62%, and 50% of patients at 30 days, 1 year, and 2 years, respectively. Patients who discontinued both thienopyridine and aspirin had a significantly higher rate of stent thrombosis than those who continued both in the intervals of 31 to 180 days, 181 to 365 days, and 366 to 548 days after stent implantation (1.76% versus 0.1%, P<0.001; 0.72% versus 0.07%, P=0.02; and 2.1% versus 0.14%, P=0.004, respectively). When discontinuation of aspirin was taken into account, patients who discontinued thienopyridine only did not have an excess of stent thrombosis in any of the time intervals studied. Adjusted rates of death or myocardial infarction at 24 months were 4.1% for patients taking thienopyridine and 4.1% for patients not taking thienopyridine (P=0.99) in the 6-month landmark analysis. CONCLUSIONS: Discontinuation of both thienopyridine and aspirin, but not discontinuation of thienopyridine therapy only, was associated with an increased risk of stent thrombosis. Landmark analysis did not suggest an apparent clinical benefit of thienopyridine use beyond 6 months after sirolimus-eluting stent implantation.
Kimura et al. (2009) conducted an observational in Sirolimus-eluting stent implantation (n=10,778). Discontinuation of both thienopyridine and aspirin vs. Continuation of both thienopyridine and aspirin was evaluated on Stent thrombosis (31 to 180 days) (p=<0.001). Discontinuation of both thienopyridine and aspirin, but not thienopyridine alone, was associated with an increased risk of stent thrombosis compared to continuing both (1.76% vs 0.1% at 31-180 days, P<0.001).