Antiplatelet therapy discontinuation following drug-eluting stent placement: dangers, reasons, and management recommendations.
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 (approximately 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 > or = 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.
Moussa
Issam D
ID
Division of Cardiology, Weill Medical College of Cornell University, 520 East 70th Street, Starr 4 Pavilion, Box 108, New York, NY 10021, USA. ism9003@med.cornell.edu
Colombo
Antonio
A
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D007722:Health Knowledge, Attitudes, Practice; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D055118:Medication Adherence; D019647:Oral Surgical Procedures / Q000009:adverse effects; D010353:Patient Education as Topic; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin