title: Double antiplatelet therapy after drug-eluting stent implantation: risk associated with discontinuation within the first year.
abstract: OBJECTIVE
  The goal of this study was to assess the risk associated with double antiplatelet therapy (DAT) discontinuation, and specifically, temporary discontinuation, during the first year after drug-eluting stent (DES) implantation.
  
  
  BACKGROUND
  Doubts remain about the risk of temporary DAT discontinuation within 1 year after DES implantation.
  
  
  METHODS
  A total of 1,622 consecutive patients undergoing DES implantation at 29 hospitals were followed up at 3, 6, 9, and 12 months to record the 1-year antiplatelet therapy discontinuation (ATD) rate, the number of days without DAT, and the rate of 1-year major cardiac events. Cox regression was used to analyze the association between ATD considered as a time-dependent covariate and 1-year cardiac events.
  
  
  RESULTS
  One hundred seventy-two (10.6%) patients interrupted at least 1 antiplatelet drug during the first year after DES implantation, although only 1 during the first month. Most (n=111, 64.5%) interrupted DAT temporarily (median: 7 days; range: 5 to 8.5): 79 clopidogrel (31 temporarily), 38 aspirin (27 temporarily), and 55 both drugs (53 temporarily). Discontinuation was followed by acute coronary syndrome in 7 (4.1%; 95% confidence interval [CI]: 1.7 to 8.2), a similar rate of major cardiac events to that in patients without ATD (n=80; 5.5%; 95% CI: 4.4 to 6.8; p=0.23). ATD was not independently associated with 1-year major cardiac events (hazard ratio: 1.32 [95% CI: 0.56 to 3.12]).
  
  
  CONCLUSIONS
  ATD within the first year and beyond the first month after DES is not exceptional, is usually temporary, and does not appear to have a large impact on risk.
authors.affiliation: Epidemiology Unit of the Cardiology Department, Vall d'Hebron Hospital, and Red de Enfermedades Cardiovasculares (RECAVA), Barcelona, Spain. nacho@ferreiragonzalez.com
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
authors.forename: Josep R
authors.initials: JR
authors.lastname: Marsal
authors.forename: Aida
authors.initials: A
authors.lastname: Ribera
authors.forename: Gaietà
authors.initials: G
authors.lastname: Permanyer-Miralda
authors.forename: Bruno
authors.initials: B
authors.lastname: García-Del Blanco
authors.forename: Gerard
authors.initials: G
authors.lastname: Martí
authors.forename: Purificación
authors.initials: P
authors.lastname: Cascant
authors.forename: Mónica
authors.initials: M
authors.lastname: Masotti-Centol
authors.forename: Xavier
authors.initials: X
authors.lastname: Carrillo
authors.forename: Josepa
authors.initials: J
authors.lastname: Mauri
authors.forename: Nuria
authors.initials: N
authors.lastname: Batalla
authors.forename: Eduard
authors.initials: E
authors.lastname: Larrousse
authors.forename: Eva
authors.initials: E
authors.lastname: Martín
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Rumoroso
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz-Salmerón
authors.forename: Jose M
authors.initials: JM
authors.lastname: de la Torre
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Jose A
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Victoria
authors.initials: V
authors.lastname: Martín-Yuste
authors.forename: Manel
authors.initials: M
authors.lastname: Sabatè
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016903:Drug Monitoring
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin