title: Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation.
abstract: BACKGROUND
  Predictors of antiplatelet therapy discontinuation (ATD) during the first year after drug-eluting stent implantation are poorly known.
  
  
  RESULTS
  This was a prospective study with 3-, 6-, 9-, and 12-month follow-up of patients receiving at least 1 drug-eluting stent between January and April 2008 in 29 hospitals. Individual- and hospital-level predictors of ATD were assessed by hierarchical-multinomial regression analysis. ATD could be assessed in 1622 candidates for follow-up (82.5%). A total of 234 patients (14.4%) interrupted at least 1 antiplatelet therapy drug, predominantly clopidogrel (n=182, 11.8%). Bleeding events or invasive procedures led to ATD in 109 patients. This was predicted by renal impairment (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.48 to 5.34), prior major hemorrhage (OR 3.77, 95% CI 1.41 to 10.03), and peripheral arterial disease (OR 1.78, 95% CI 1.01 to 3.15). Medical decisions led to ATD in 70 patients; this was predicted by long-term use of anticoagulant therapy (OR 3.88, 95% CI 1.26 to 11.98), undergoing the procedure in a private hospital (OR 13.3, 95% CI 1.69 to 105), and not receiving instructions about medication (OR 2.8, 95% CI 1.23 to 6.36). Thirty-nine patients interrupted ATD on their own initiative, mainly immigrants (OR 3.78, 95% CI 1.2 to 11.98) and consumers of psychotropic drugs (OR 2.58, 95% CI 1.3 to 5.12).
  
  
  CONCLUSIONS
  ATD during the first year after drug-eluting stent implantation is based mainly on patient decision or a medical decision not associated with major bleeding events or major surgical procedures. Individual- and hospital-level variables are important to predict ATD.
authors: Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain. nacho@ferreiragonzalez.com
authors: Ignacio
authors: I
authors: Ferreira-González
authors: Josep R
authors: JR
authors: Marsal
authors: Aida
authors: A
authors: Ribera
authors: Gaietà
authors: G
authors: Permanyer-Miralda
authors: Bruno
authors: B
authors: García-Del Blanco
authors: Gerard
authors: G
authors: Martí
authors: Purificación
authors: P
authors: Cascant
authors: Victoria
authors: V
authors: Martín-Yuste
authors: Salvatore
authors: S
authors: Brugaletta
authors: Manuel
authors: M
authors: Sabaté
authors: Fernando
authors: F
authors: Alfonso
authors: Mari L
authors: ML
authors: Capote
authors: Jose M
authors: JM
authors: De La Torre
authors: Marta
authors: M
authors: Ruíz-Lera
authors: Dario
authors: D
authors: Sanmiguel
authors: Mérida
authors: M
authors: Cárdenas
authors: Beth
authors: B
authors: Pujol
authors: Jose A
authors: JA
authors: Baz
authors: Andrés
authors: A
authors: Iñiguez
authors: Ramiro
authors: R
authors: Trillo
authors: Omar
authors: O
authors: González-Béjar
authors: Juan
authors: J
authors: Casanova
authors: Joaquín
authors: J
authors: Sánchez-Gila
authors: David
authors: D
authors: García-Dorado
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D004334:Drug Administration Schedule; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology; D012651:Self Medication / Q000706:statistics & numerical data; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016903:Drug Monitoring
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine