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Risk of discontinuation of clopidogrel after 1 month following bare-metal stents: a propensity-score adjusted comparison with continued administration of clopidogrel after drug-eluting stents

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Abstract

In patients at high risk for bleeding undergoing percutaneous coronary intervention (PCI) the use of bare-metal-stent (BMS) is considered an option that allows discontinuation of clopidogrel after 4 weeks. We sought to investigate the risk of early discontinuation of clopidogrel in patients with BMS as compared with a 6-month course of clopidogrel after DES in patients with or without high on-treatment platelet reactivity (HTPR). In 765 consecutive patients undergoing PCI after loading with clopidogrel 600 mg, HTPR was tested by optical aggregometry and defined as residual platelet reactivity > 14%. On top of aspirin 100 mg, patients received clopidogrel 75 mg for 4 weeks after BMS or 6 months after DES. The primary endpoint was all-cause mortality or myocardial infarction (MI) during 1 year. The 1-year incidence of death or MI was 3.5% with BMS (n = 484), 0.9% with DES and no HTPR (n = 211), and 7.1% with DES and HTPR (n = 70; p = 0.03). Landmark analyses for the first 6 months demonstrated that the risk of patients receiving BMS was similar as in patients receiving a DES with HTPR during this period (2.3 vs. 2.9%) but lowest in patients receiving a DES without HTPR (0.5%). The incidence of bleeding was similar in all three groups. These findings did not change after propensity score adjustment for stent type. After discontinuation of clopidogrel at 1 month, patients treated with BMS are at higher risk for death or MI than patients treated with a DES and sufficiently responding to clopidogrel planned for 6 months.

ClinicalTrials.gov number NCT00457236

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Funding

This trial was supported by the University Heart Center Freiburg · Bad Krozingen.

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Authors and Affiliations

  1. Department of Cardiology and Angiology II, University Heart Center Freiburg · Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany

    Christian M. Valina, Sebastian Merz, Nikolaus Löffelhardt, Michael Amann, Miroslaw Ferenc, Christian Stratz, Franz-Josef Neumann & Willibald Hochholzer

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  1. Christian M. Valina
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  2. Sebastian Merz
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Correspondence to Christian M. Valina.

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Conflict of interest

Dr. Hochholzer reports receiving consulting and lecture fees from AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, and The Medicines Company. Dr. Stratz reports receiving lecture fees from Eli Lilly. All other authors report no conflict of interests.

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Valina, C.M., Merz, S., Löffelhardt, N. et al. Risk of discontinuation of clopidogrel after 1 month following bare-metal stents: a propensity-score adjusted comparison with continued administration of clopidogrel after drug-eluting stents. J Thromb Thrombolysis 45, 432–439 (2018). https://doi.org/10.1007/s11239-018-1613-6

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