Key result
Clopidogrel withdrawal at 21 months triggers very late paclitaxel-eluting stent thrombosis.
Why the study?
Drug-eluting stents have a slightly higher incidence of stent thrombosis compared to bare metal stents, and the optimal duration of clopidogrel treatment remains a concern.
Case Report (n=1)
Highlights the risk of very late stent thrombosis following clopidogrel withdrawal even after prolonged dual antiplatelet therapy in patients with paclitaxel-eluting stents.
Alerts clinicians to very late DES thrombosis risk after clopidogrel cessation; leaves open optimal DAPT duration.
Drug-eluting stents (DES) present a slightly higher incidence of stent thrombosis compared to bare metal stents and some cases of DES thrombosis are described in the literature. Therefore, there is consensus in recommending treatment with clopidogrel for at least 6 months in addition to life-long aspirin administration. We describe a case of very late paclitaxel-eluting stent thrombosis despite 21 months of clopidogrel treatment, which occurred just 2 weeks after its withdrawal, causing an acute coronary syndrome that was promptly resolved with an urgent invasive strategy. In our experience, paclitaxel-eluting stent thrombosis can occur several months after stent implantation despite prolonged clopidogrel treatment.
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Sardella et al. (2007) conducted a case report in Very late paclitaxel-eluting stent thrombosis (n=1). Clopidogrel withdrawal was evaluated on Very late stent thrombosis. Clopidogrel withdrawal after 21 months of treatment resulted in very late paclitaxel-eluting stent thrombosis and acute coronary syndrome in a single patient.
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