Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation.
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.
Ferreira-González
Ignacio
I
Epidemiology Unit, Cardiology Department, University Hospital Vall d'Hebron, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain. nacho@ferreiragonzalez.com
Marsal
Josep R
JR
Ribera
Aida
A
Permanyer-Miralda
Gaietà
G
García-Del Blanco
Bruno
B
Martí
Gerard
G
Cascant
Purificación
P
Martín-Yuste
Victoria
V
Brugaletta
Salvatore
S
Sabaté
Manuel
M
Alfonso
Fernando
F
Capote
Mari L
ML
De La Torre
Jose M
JM
Ruíz-Lera
Marta
M
Sanmiguel
Dario
D
Cárdenas
Mérida
M
Pujol
Beth
B
Baz
Jose A
JA
Iñiguez
Andrés
A
Trillo
Ramiro
R
González-Béjar
Omar
O
Casanova
Juan
J
Sánchez-Gila
Joaquín
J
García-Dorado
David
D
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
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine