Antiplatelet therapy discontinuation following drug‐eluting stent placement: Dangers, reasons, and management recommendations
- 22 July 2009
- journal article
- review article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 74 (7), 1047-1054
- https://doi.org/10.1002/ccd.22167
Abstract
Drug‐eluting stents (DES) have several advantages over bare‐metal stents (BMS), including significantly lower target vessel revascularization. However, DES is associated with a higher incidence of late stent thrombosis (ST). Although late ST after DES placement is uncommon (∼0.4–0.6%/year), it is catastrophic clinical consequences make it a concern. Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is the standard of care for prevention of ST, and DAT discontinuation is associated with a marked increase in ST risk. These guidelines recommend continuing DAT for ≥12 months after DES implantation in patients not at high risk for bleeding. Premature DAT discontinuation is common in clinical practice. Therefore, it is imperative that physicians be aware of factors contributing to discontinuation, including cost, patient education, and actual bleeding events, so as to educate their patients about the risks and benefits of continued DAT. This review highlights the risks of premature DAT discontinuation, discusses common reasons for discontinuation, and offers potential solutions to improve adherence.Keywords
This publication has 44 references indexed in Scilit:
- Unplanned surgery after drug eluting stent implantation: a strategy for safe temporary withdrawal of dual oral antiplatelet therapyJournal of Cardiovascular Medicine, 2008
- Drug-Eluting Stent ThrombosisJournal of the American College of Cardiology, 2008
- 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary InterventionCell Metabolism, 2008
- Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysisThe Lancet, 2007
- Safety and Efficacy of Sirolimus- and Paclitaxel-Eluting Coronary StentsNew England Journal of Medicine, 2007
- Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort studyThe Lancet, 2007
- Incidence, Predictors, and Outcome of Thrombosis After Successful Implantation of Drug-Eluting StentsJAMA, 2005
- A Polymer-Based, Paclitaxel-Eluting Stent in Patients with Coronary Artery DiseaseNew England Journal of Medicine, 2004
- Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary ArteryNew England Journal of Medicine, 2003
- Intracoronary Stenting Without Anticoagulation Accomplished With Intravascular Ultrasound GuidanceCell Metabolism, 1995