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Risk of Early Adverse Events After Clopidogrel Discontinuation in Patients Undergoing Short-Term Dual Antiplatelet Therapy: An Individual Participant Data Analysis

Authors
 Raffaele Piccolo  ;  Fausto Feres  ;  Alexandre Abizaid  ;  Martine Gilard  ;  Marie-Claude Morice  ;  Myeong-Ki Hong  ;  Hyo-Soo Kim  ;  Antonio Colombo  ;  Deepak L. Bhatt  ;  Tullio Palmerini  ;  Gregg W. Stone  ;  Stephan Windecker  ;  Marco Valgimigli 
Citation
 JACC-CARDIOVASCULAR INTERVENTIONS, Vol.10(16) : 1621-1630, 2017 
Journal Title
 JACC-CARDIOVASCULAR INTERVENTIONS 
ISSN
 1936-8798 
Issue Date
2017
MeSH
Aged ; Aspirin/administration & dosage* ; Aspirin/adverse effects ; Coronary Restenosis/etiology ; Coronary Thrombosis/etiology ; Drug Administration Schedule ; Drug Therapy, Combination ; Drug-Eluting Stents ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Percutaneous Coronary Intervention*/adverse effects ; Percutaneous Coronary Intervention*/instrumentation ; Percutaneous Coronary Intervention*/mortality ; Platelet Aggregation Inhibitors/administration & dosage* ; Platelet Aggregation Inhibitors/adverse effects ; Proportional Hazards Models ; Purinergic P2Y Receptor Antagonists/administration & dosage* ; Purinergic P2Y Receptor Antagonists/adverse effects ; Randomized Controlled Trials as Topic ; Risk Factors ; Stroke/etiology ; Ticlopidine/administration & dosage ; Ticlopidine/adverse effects ; Ticlopidine/analogs & derivatives* ; Time Factors ; Treatment Outcome
Keywords
clopidogrel ; dual antiplatelet therapy ; percutaneous coronary intervention
Abstract
OBJECTIVES: The study sought to evaluate the presence of a clinically relevant rebound phenomenon after dual antiplatelet therapy (DAPT) discontinuation in randomized trials. BACKGROUND: It is currently unknown whether clopidogrel discontinuation after short-term DAPT is associated with an early hazard of ischemic events. METHODS: The authors performed an individual participant data analysis and aggregate meta-analysis. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), defined as the composite of cardiac death, myocardial infarction (MI), or stroke. RESULTS: The study included 11,473 PCI patients with individual participant data from 6 randomized trials comparing short-term DAPT (3 or 6 months) versus long-term DAPT (12 months or more). During the first 90 days following clopidogrel discontinuation, there was no significant increase in the risk of MACCE between patients randomized to short-term DAPT compared with long-term DAPT (hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 0.71 to 1.98; p = 0.52; absolute risk difference 0.10%; 95% CI: -0.16% to 0.36%). The risk of MI or stent thrombosis was similar among patients randomized to short-term DAPT versus long-term DAPT (HR: 0.93; 95% CI: 0.46 to 1.90; p = 0.85). In the aggregate data meta-analysis of 11 trials including 38,919 patients, a higher risk of early MACCE was observed after long-term (≥12 months) DAPT duration (HR: 2.28; 95% CI: 1.69 to 3.09; p < 0.001) but not short-term (<12 months) DAPT duration (HR: 1.08; 95% CI: 0.67 to 1.74; p for interaction = 0.036). CONCLUSIONS: Among patients undergoing PCI with predominantly new-generation DES, discontinuation of clopidogrel after 3 or 6 months DAPT duration was not associated with an early increase in adverse clinical events. An early increase in MACCE was observed after long-term (≥12 months) DAPT exposure.
Full Text
https://www.sciencedirect.com/science/article/pii/S1936879817311123
DOI
10.1016/j.jcin.2017.06.001
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160745
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