title: Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study.
abstract: BACKGROUND
  The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available.
  
  
  METHODS
  We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases.
  
  
  RESULTS
  Discontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation.
  
  
  CONCLUSIONS
  Discontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.
authors.forename: Troels
authors.initials: T
authors.lastname: Thim
authors.forename: Martin Berg
authors.initials: MB
authors.lastname: Johansen
authors.forename: Gro Egholm
authors.initials: GE
authors.lastname: Chisholm
authors.forename: Morten
authors.initials: M
authors.lastname: Schmidt
authors.forename: Anne
authors.initials: A
authors.lastname: Kaltoft
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Steen Dalby
authors.initials: SD
authors.lastname: Kristensen
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
authors.forename: Lars Romer
authors.initials: LR
authors.lastname: Krusell
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. michael.maeng@ki.au.dk.
authors.forename: Michael
authors.initials: M
authors.lastname: Maeng
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D003718:Denmark; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine