title: Clopidogrel Therapy Discontinuation Following Drug Eluting Stent Implantation in Real World Practice in Israel.
abstract: BACKGROUND
  Incidence and predictors of clopidogrel discontinuation after drug eluting stent (DES) implantation, in real world practice, are poorly known.
  
  
  METHODS
  Prospective study included all patients who underwent implantation of at least one DES between February 2006 and January 2007. Predictors of clopidogrel discontinuation were assessed by a multivariable analysis.
  
  
  RESULTS
  In 269 patients, mean period for clopidogrel therapy was 13.2 ± 7.2 month. Twenty eight patients (10.4%) discontinued clolopidogrel prematurely (< 3 months). Early clopidogrel discontinuation was a predictor of late stent thrombosis (P = 0.005) and urgent target vessel revascularization (P = 0.05). There was a trend for higher cardiac mortality among that group (P = 0.07). By 12 months, 173 patients (64.3%) have discontinued clopidogrel therapy. The most frequent circumstance to stop clopidogrel before 12 months was recommendation of family physician. Patients that were followed by cardiologist were more encouraged to longer clopidogrel therapy. In multivariable analysis being non Jew (OR 19.2, 95% CI 2.4 to 142, P = 0.005), not followed by cardiologist (OR 4.7, 95% CI 1 to 23.1, P = 0.05) and lack of information regarding the importance of clopidogrel maintenance at discharge from hospital (OR 10.8, 95% CI 2.7 to 42.9, P = 0.001) were independent predictors of early clopidogrel discontinuation.
  
  
  CONCLUSIONS
  Clopidogrel discontinuation, in real world practice is not unusual and related to poor outcome. Education for general physicians, clear instructions about the importance of antiplatelet maintenance at discharge and follow up by an expert cardiologist are opportunities to improve adherence do antiplatelet therapy following DES implantation.
authors.affiliation: Department of Cardiology, "Rambam" Health Care Campus and the Technion Medical School, Haifa, Israel.
authors.forename: Miry
authors.initials: M
authors.lastname: Blich
authors.affiliation: Department of Cardiology, "Rambam" Health Care Campus and the Technion Medical School, Haifa, Israel.
authors.forename: Tawfiq Zeidan
authors.initials: TZ
authors.lastname: Shwiri
authors.affiliation: Department of Cardiology, "Rambam" Health Care Campus and the Technion Medical School, Haifa, Israel.
authors.forename: Sirouch
authors.initials: S
authors.lastname: Petcherski
authors.affiliation: Department of Cardiology, "Rambam" Health Care Campus and the Technion Medical School, Haifa, Israel.
authors.forename: Azriel B
authors.initials: AB
authors.lastname: Osherov
authors.affiliation: Department of Cardiology, "Rambam" Health Care Campus and the Technion Medical School, Haifa, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Hammerman
keywords: Clopidogrel Therapy; Discontinuation; Drug Eluting Stent; Implantation