CardiologyOnline.net

Cardiology Xagena

Xagena Mappa
Xagena Newsletter
OncologiaMedica.net
Medical Meeting

Dual antiplatelet therapy beyond 1 year after placement of a drug-eluting stent reduces the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events, compared with Aspirin therapy alone


Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain.

Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed.

After 12 months of treatment with a thienopyridine drug ( Clopidogrel [ Plavix ] or Prasugrel [ Efient, Effient ] ) and Acetylsalicylic acid ( Aspirin ), patients were randomly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months; all patients continued receiving Aspirin.

The coprimary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events ( a composite of death, myocardial infarction, or stroke ) during the period from 12 to 30 months.
The primary safety end point was moderate or severe bleeding.

A total of 9961 patients were randomly assigned to continue thienopyridine treatment or to receive placebo.

Continued treatment with thienopyridine, as compared with placebo, reduced the rates of stent thrombosis ( 0.4% vs 1.4%; hazard ratio, HR=0.29 [ 95% confidence interval {CI}, 0.17 to 0.48 ]; P less than 0.001 ) and major adverse cardiovascular and cerebrovascular events ( 4.3% vs 5.9%; HR=0.71 [ 95% CI, 0.59 to 0.85 ]; P less than 0.001 ).

The rate of myocardial infarction was lower with thienopyridine treatment than with placebo ( 2.1% vs 4.1%; HR=0.47; P less than 0.001 ).

The rate of death from any cause was 2.0% in the group that continued thienopyridine therapy and 1.5% in the placebo group ( HR=1.36 [ 95% CI, 1.00 to 1.85 ]; P=0.05 ).

The rate of moderate or severe bleeding was increased with continued thienopyridine treatment ( 2.5% vs 1.6%, P=0.001 ).

An elevated risk of stent thrombosis and myocardial infarction was observed in both groups during the 3 months after discontinuation of thienopyridine treatment.

In conclusion, dual antiplatelet therapy beyond 1 year after placement of a drug-eluting stent, as compared with Aspirin therapy alone, significantly reduced the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events but was associated with an increased risk of bleeding. ( Xagena )

Mauri L et al, N Engl J Med 2014; 371:2155-2166

XagenaMedicine_2014



Indietro