Duration of dual antiplatelet therapy after implantation of drug-eluting stents.

نویسندگان

  • Seung-Jung Park
  • Duk-Woo Park
  • Young-Hak Kim
  • Soo-Jin Kang
  • Seung-Whan Lee
  • Cheol Whan Lee
  • Ki-Hoon Han
  • Seong-Wook Park
  • Sung-Cheol Yun
  • Sang-Gon Lee
  • Seung-Woon Rha
  • In-Whan Seong
  • Myung-Ho Jeong
  • Seung-Ho Hur
  • Nae-Hee Lee
  • Junghan Yoon
  • Joo-Young Yang
  • Bong-Ki Lee
  • Young-Jin Choi
  • Wook-Sung Chung
  • Do-Sun Lim
  • Sang-Sig Cheong
  • Kee-Sik Kim
  • Jei Keon Chae
  • Deuk-Young Nah
  • Doo-Soo Jeon
  • Ki Bae Seung
  • Jae-Sik Jang
  • Hun Sik Park
  • Keun Lee
چکیده

BACKGROUND The potential benefits and risks of the use of dual antiplatelet therapy beyond a 12-month period in patients receiving drug-eluting stents have not been clearly established. METHODS In two trials, we randomly assigned a total of 2701 patients who had received drug-eluting stents and had been free of major adverse cardiac or cerebrovascular events and major bleeding for a period of at least 12 months to receive clopidogrel plus aspirin or aspirin alone. The primary end point was a composite of myocardial infarction or death from cardiac causes. Data from the two trials were merged for analysis. RESULTS The median duration of follow-up was 19.2 months. The cumulative risk of the primary outcome at 2 years was 1.8% with dual antiplatelet therapy, as compared with 1.2% with aspirin monotherapy (hazard ratio, 1.65; 95% confidence interval [CI], 0.80 to 3.36; P=0.17). The individual risks of myocardial infarction, stroke, stent thrombosis, need for repeat revascularization, major bleeding, and death from any cause did not differ significantly between the two groups. However, in the dual-therapy group as compared with the aspirin-alone group, there was a nonsignificant increase in the composite risk of myocardial infarction, stroke, or death from any cause (hazard ratio, 1.73; 95% CI, 0.99 to 3.00; P=0.051) and in the composite risk of myocardial infarction, stroke, or death from cardiac causes (hazard ratio, 1.84; 95% CI, 0.99 to 3.45; P=0.06). CONCLUSIONS The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received drug-eluting stents was not significantly more effective than aspirin monotherapy in reducing the rate of myocardial infarction or death from cardiac causes. These findings should be confirmed or refuted through larger, randomized clinical trials with longer-term follow-up. (ClinicalTrials.gov numbers, NCT00484926 and NCT00590174.)

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Dual Antiplatelet Therapy for 6 Months vs 12 Months After New-generation Drug-eluting Stent Implantation: Matched Analysis of ESTROFA-DAPT and ESTROFA-2.

INTRODUCTION AND OBJECTIVES The recommendation for dual antiplatelet therapy following drug-eluting stent implantation ranges from 6 months to 12 months or beyond. Recent trials have suggested the safety of a 6-month dual antiplatelet therapy regimen, yet certain caveats to these studies limit the applicability of this shorter duration dual antiplatelet therapy strategy in real world settings. ...

متن کامل

Interventional Cardiology Short- Versus Long-Term Duration of Dual-Antiplatelet Therapy After Coronary Stenting A Randomized Multicenter Trial

Background—The optimal duration of dual-antiplatelet therapy and the risk-benefit ratio for long-term dual-antiplatelet therapy after coronary stenting remain poorly defined. We evaluated the impact of up to 6 versus 24 months of dual-antiplatelet therapy in a broad all-comers patient population receiving a balanced proportion of Food and Drug Administration–approved drug-eluting or bare-metal ...

متن کامل

Dual antiplatelet therapy after drug-eluting stents--how long to treat?

The rationale behind dual antiplatelet therapy after successful stenting is based upon two indications. First, the stented segment requires protection from stent thrombosis that occurs as a result of inflammation during healing. Second, the areas inside and outside the stented section require protection from the development of progressive atherosclerosis and plaque rupture. The first of these t...

متن کامل

Simultaneous Thrombosis of Two Drug-Eluting Stents After Discontinuation of Dual Antiplatelet Therapy for a Day

Stent thrombosis is rare but can lead to potential severe consequence. The incidence is relative higher in drug-eluting sent than bare-metal stent implantation. Dual antiplatelet therapy is the major treatment to avoid early and late stent thrombosis. Simultaneous two stents thrombosis is rare. Although mechanical or/and procedure factors may predispose to stent thrombosis occurred, simultaneou...

متن کامل

Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials

ObjeCtive To assess the benefits and risks of short term (<12 months) or extended (>12 months) dual antiplatelet therapy (DAPT) versus standard 12 month therapy, following percutaneous coronary intervention with drug eluting stents. Design Meta-analysis of randomised controlled trials. Data sOurCes PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science,...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • The New England journal of medicine

دوره 362 15  شماره 

صفحات  -

تاریخ انتشار 2010