Key result
The FDA panel concluded that on-label drug-eluting stent use does not increase death or MI but increases very late stent thrombosis, whereas off-label use increases the risk of death or MI.
A 2006 FDA panel concluded that while on-label DES use increases very late stent thrombosis without increasing death or MI, off-label use increases death or MI, supporting guidelines for at least 12 months of dual antiplatelet therapy.
Supports prolonged DAPT after drug-eluting stents; leaves open optimal strategies for off-label use.
Drug-eluting stents (DES) seemed likely to mitigate the problem of restenosis and have become the predominant stent deployed during percutaneous coronary intervention (PCI). Sustained concerns about the rate of stent thrombosis (ST), particularly very late ST (>1 year following PCI) led to a meeting of the Circulatory System Devices Advisory Panel to address "on-label" and "off-label" use as well as appropriate duration of dual antiplatelet therapy following DES. Over 40 presentations by members of the FDA, industry personnel, and leaders in the field of interventional cardiology helped set forth the body of data available on DES. Standardized definitions of ST created by the Academic Research Consortium were applied to existing randomized trials and registries. At the end of the 2-day session, the consensus of the panel was that "on-label" DES use is not associated with increased incidence of death and myocardial infarction (MI), although it is associated with increased rates of very late ST. "Off-label" use is associated with increased risk of death or MI when compared with "on-label" use. Insufficient data exist to determine the duration of clopidogrel that would minimize ST and bleeding risk, but the panel agreed with the current ACC/AHA/SCAI guidelines regarding dual antiplatelet therapy for at least 12 months in patients at low risk for bleeding, especially with "off-label" use. More data from trials designed with better control arms and prespecified analyses of complex patients and lesions subsets over longer periods of follow-up are needed.
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Slottow et al. (2007) conducted a review in Drug-eluting stent thrombosis. Drug-eluting stents (on-label vs off-label use) was evaluated. The FDA panel concluded that on-label drug-eluting stent use does not increase death or MI but increases very late stent thrombosis, whereas off-label use increases the risk of death or MI.
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