Antiplatelet therapy and stent thrombosis after sirolimus-eluting stent implantation.
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.


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
Takeshi
T
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan. taketaka@kuhp.kyoto-u.ac.jp
Morimoto
Takeshi
T
Nakagawa
Yoshihisa
Y
Tamura
Toshihiro
T
Kadota
Kazushige
K
Yasumoto
Hitoshi
H
Nishikawa
Hideo
H
Hiasa
Yoshikazu
Y
Muramatsu
Toshiya
T
Meguro
Taiichiro
T
Inoue
Naoto
N
Honda
Hidehiko
H
Hayashi
Yasuhiko
Y
Miyazaki
Shunichi
S
Oshima
Shigeru
S
Honda
Takashi
T
Shiode
Nobuo
N
Namura
Masanobu
M
Sone
Takahito
T
Nobuyoshi
Masakiyo
M
Kita
Toru
T
Mitsudo
Kazuaki
K
D000368:Aged; D000369:Aged, 80 and over; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use; D020123:Sirolimus / Q000008:administration & dosage*; D013927:Thrombosis / Q000209:etiology*
D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D020123:Sirolimus