Safety of short-term discontinuation of antiplatelet therapy in patients with drug-eluting stents.
BACKGROUND
Antiplatelet therapy is often discontinued in patients with drug-eluting stents who are undergoing surgical procedures. However, discontinuation of antiplatelet therapy is an important risk factor for late stent thrombosis. Our objective was to examine the safety of short-term discontinuation of antiplatelet therapy.


RESULTS
We systematically searched Medline for reported cases of late stent thrombosis and very late stent thrombosis published between January 2001 and July 2008. We restricted our search to Academic Research Consortium-defined definite cases. We identified 161 cases of late stent thrombosis or very late stent thrombosis from 84 articles (79 from case reports, 61 from registries, and 21 from randomized clinical trials). Patients had a mean age of 58.4+/-13.4 years, and 88% were male. A total of 19 cases occurred in patients who were receiving dual antiplatelet therapy at the time of the event. If patients stopped both antiplatelet agents simultaneously, the median time to event was 7 days. If patients had previously stopped a thienopyridine with no ill effect and subsequently stopped acetylsalicylic acid, the median time to event was also 7 days from the time of acetylsalicylic acid cessation. If the thienopyridine was stopped but acetylsalicylic acid was maintained, the median time to event was 122 days. Among the 48 patients who stopped both agents, 36 cases (75%) occurred within 10 days. Among the 94 patients who discontinued a thienopyridine but continued acetylsalicylic acid, only 6 cases (6%) occurred within 10 days.


CONCLUSIONS
If acetylsalicylic acid therapy is maintained, short-term discontinuation of a thienopyridine may be relatively safe in patients with drug-eluting stents.
Eisenberg
Mark J
MJ
Division of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Cote Ste Catherine Rd, Suite A-118, Montreal, Quebec H3T1E2, Canada. mark.eisenberg@mcgill.ca
Richard
Pierre R
PR
Libersan
Danielle
D
Filion
Kristian B
KB
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D016022:Case-Control Studies; D003625:Data Collection; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D016239:MEDLINE; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013927:Thrombosis / Q000209:etiology*
D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D001241:Aspirin