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Word of the Day

24 months of clopidogrel after stent no better than 6 months

Clinical Question:
Is 24 months of clopidogrel more effective than 6 months of clopidogrel after stent placement?

Bottom Line:
It is not uncommon to find patients still taking clopidogrel (Plavix) plus aspirin years after their stent was placed. This study found that there is no benefit, but definite harm and cost, to extending treatment beyond 6 months. It is important for us to work with our cardiology colleagues to make sure that patients only take these drugs for as long as necessary, and no longer. (LOE = 1b)

Reference:
Valgimigli M, Campo G, Monti M, et al. Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicentre trial. Circulation 2012 Mar 21 [Epub ahead of print].  [PMID:22438530]

Study Design:
Randomized controlled trial (single-blinded)

Funding:
Self-funded or unfunded

Allocation:
Concealed

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
These researchers randomized 2013 patients to 1 of 4 stents: everolimus eluting, paclitaxel eluting, zotarolimus eluting, or bare metal. They then randomized all of the patients to 6 months or 24 months of dual antiplatelet therapy with aspirin plus clopidogrel. Patients were followed up for 2 years.The primary outcome was a composite of all-cause mortality, nonfatal myocardial infarction, and cerebrovascular accident. The mean age of patients was 68 years, 25% had diabetes, and the median number of lesions stented was one. Groups were balanced at the start of the study, and analysis was by intention to treat. Patients in the 6-month group who received a bare metal stent were allowed to discontinue the drug after 1 month based on current guidelines. There was no difference between groups in all-cause mortality, cardiovascular mortality, myocardial infarction, or cerebrovascular accident. Bleeding was more common in the group receiving clopidogrel for 24 months, though.

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