title: Prevalence, predictors, and long-term prognosis of premature discontinuation of oral antiplatelet therapy after drug eluting stent implantation.
abstract: To date, limited information is available on the long-term discontinuation rates of antiplatelet therapy after drug-eluting stent implantation. The aim of the present study was to determine the prevalence and predictors of premature discontinuation of oral antiplatelet therapy after drug-eluting stent implantation and to evaluate its effects on long-term prognosis. We studied 1,358 consecutive patients successfully treated with drug-eluting stents and discharged with dual oral antiplatelet therapy. Aspirin was to be maintained lifelong, and clopidogrel was prescribed for 12 months. The patients were followed for 36 months. The prevalence and predictors of aspirin and clopidogrel discontinuation were assessed. Major adverse cardiac events, defined as death, myocardial infarction, destabilizing symptoms leading to hospitalization, and nonfatal stroke, were recorded. Definite, probable, and possible stent thrombosis (ST) and major and minor bleeding were also determined. Of the 1,358 patients, 8.8% had discontinued one or both antiplatelet agents within the first 12 months ("early" discontinuation) and 4.8% had discontinued aspirin after 1 year ("late" discontinuation). Early discontinuation was predicted by in-hospital major bleeding, the use of oral anticoagulants at discharge, and the lack of a statin prescription. Previous stroke was the only independent predictor of late discontinuation. Patients with early discontinuation experienced a greater incidence of major adverse cardiac events (28.6% vs 13.7%, p <0.001) and ST (7.6% vs 3.4%, p = 0.038). All-cause mortality (13.4% vs 4.7%, p <0.001) and cardiovascular death (5% vs 1.2%, p = 0.007) were significantly more frequent among patients with early discontinuation. In patients with late discontinuation, a nonstatistically significant increase was seen in major adverse cardiac events (20% vs 13.3%, p = 0.128) and ST (6.2% vs 3.2%, p = 0.275). In conclusion, premature discontinuation of antiplatelet therapy is relatively common, especially within the first year, and strongly associated with increased cardiovascular events, including ST and death.
authors.affiliation: USC Cardiologia, Dipartimento Cardiovascolare, Ospedali Riuniti di Bergamo, Italy. roberta_rossini@yahoo.it
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.forename: Tamar
authors.initials: T
authors.lastname: Nijaradze
authors.forename: Michele
authors.initials: M
authors.lastname: Romano
authors.forename: Nikoloz
authors.initials: N
authors.lastname: Lortkipanidze
authors.forename: Nicola
authors.initials: N
authors.lastname: Cicorella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi Zoccai
authors.forename: Vasile
authors.initials: V
authors.lastname: Sirbu
authors.forename: Antonio
authors.initials: A
authors.lastname: Izzo
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
mesh_terms: D000284:Administration, Oral; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003328:Coronary Thrombosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011182:Postoperative Care / Q000379:methods*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D010975:Platelet Aggregation Inhibitors