title: Is Extended Duration of Dual Antiplatelet Therapy After Carotid Stenting Beneficial?
abstract: The optimal antithrombotic regimen after carotid artery stenting (CAS) remains uncertain. We aimed to elucidate if long-term duration of aspirin plus clopidogrel after CAS would provide clinically relevant benefit. Patients receiving CAS were identified from the National Health Insurance Research Database, Taiwan. The discharge date following CAS was defined as index date. The study participants were divided into groups according to the prescribed duration of antiplatelet after the index date. They included the insufficient (< 30 days), moderate (30-41 days), and considerable (≥ 42 days) groups. The risk of ischemic stroke, composite vascular outcome, and death were interested outcomes. To eliminate event-related prescription change, all outcomes that occurred within 42 days were excluded. Follow-up started 42 days after the index date and was censored when an event occurred or at 6 months. A total of 4903 patients received CAS from 2004 to 2011. The total participants recruited for analysis (n = 2829) included the insufficient (n = 688), moderate (n = 372), and considerable groups (n = 1769). The event rates of ischemic stroke (3.92, 2.69, and 2.77%, P = 0.30), composite vascular stroke (5.52, 4.03, and 4.41%, P = 0.42), and death (3.05, 2.42, and 2.32%, P = 0.58) were similar for each group. Cox regression did not demonstrate significant associations between antiplatelet duration and the outcomes of interest. Long-term use of aspirin plus clopidorel after CAS did not decrease the risk of ischemic stroke, composite vascular events, or death during 6 months of follow-up. More research on the appropriate duration of post-CAS dual antiplatelet is essential.
authors.affiliation: From the Department of Public Health and Institute of Public Health, Chung Shan Medical, University, Taichung City (K-MJ, J-YH, ONN, Z-HJ, W-YK, Y-PL); Department of Neurology, Changhua Christian Hospital, Changhua (K-MJ); Department of Pharmacy, Taichung Veterans General Hospital (Y-CT); and Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan (Y-PL).
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Jhang
authors.forename: Jing-Yang
authors.initials: JY
authors.lastname: Huang
authors.forename: Oswald Ndi
authors.initials: ON
authors.lastname: Nfor
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Jian
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Tung
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Ku
authors.forename: Yung-Po
authors.initials: YP
authors.lastname: Liaw
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000628:therapy; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin