title: Prevalence and Predictors of Early Discontinuation of Dual-Antiplatelet Therapy After Drug-Eluting Stent Implantation in Korean Population.
abstract: The administration of antiplatelet drugs for months after a drug-eluting stent implantation is critical in decreasing the risk of complications, and premature discontinuation of antiplatelet therapy before the recommended period is the most important predictor for late complications. Therefore, we investigated the prevalence and associated factors of premature discontinuation of antiplatelet therapy in patients in Korea. This retrospective cohort study was conducted using the Korean National Health Insurance Service-National Sample Cohort data. Patients who were treated with dual-antiplatelet therapy (DAPT) were identified with medication prescription data. The Kaplan-Meier failure time plot was used to illustrate the cumulative probability of treatment discontinuation. Cox regression analysis was conducted to compare predictors of early discontinuation of DAPT. The characteristics of the early discontinuation group were not significantly different from the guideline concordance group, except for a higher prevalence of disability and a lower rate of chronic kidney disease. In a Cox regression model, the presence of hypertension was identified as a negative predictor of early discontinuation, and disability was not a statistically significant predictor. The prevalence of early discontinuation was 31.0% and seems to be significantly higher than those reported from prospective studies, which may more accurately reflect the real-world situation. In conclusion, physicians should make more effort to educate patients on the risk associated with premature discontinuation of antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent, and further studies investigating the reasons for nonadherence of DAPT are needed to improve DAPT compliance.
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Mi Hee
authors.initials: MH
authors.lastname: Cho
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: dwshin.snuh@gmail.com.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Shin
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jae Moon
authors.initials: JM
authors.lastname: Yun
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Joong Hyun
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Seung Pyo
authors.initials: SP
authors.lastname: Lee
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyejin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Yoo Kyoung
authors.initials: YK
authors.lastname: Lim
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Eun Ha
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyun Kyoung
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000517:prevention & control; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery*; 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; D010349:Patient Compliance; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin