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Short- Versus Long-Term Duration of Dual-Antiplatelet Therapy After Coronary Stenting



Short- Versus Long-Term Duration of Dual-Antiplatelet Therapy After Coronary Stenting

Marco Valgimigli, MD, PhD; Gianluca Campo, MD; Monia Monti, BSc; Pascal Vranckx, MD; Gianfranco Percoco, MD; Carlo Tumscitz, MD; Fausto Castriota, MD; Federico Colombo, MD; Matteo Tebaldi, MD; Giuseppe Fucà, MD; Moh'd Kubbajeh, MD; Elisa Cangiano, MD; Monica Minarelli, MD; Antonella Scalone, MD; Caterina Cavazza, MD; Alice Frangione, MD; Marco Borghesi, MD; Jlenia Marchesini, MD; Giovanni Parrinello, PhD; Roberto Ferrari, MD, PhD

Circulation,
125:16, March 21, 2012

Short- Versus Long-Term Duration of Dual-Antiplatelet Therapy After Coronary Stenting

 

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 stents. 
 
 
Methods and Results
We randomly assigned 2013 patients to receive bare-metal, zotarolimus-eluting, paclitaxel-eluting, or everolimus-eluting stent implantation. At 30 days, patients in each stent group were randomly allocated to receive up to 6 or 24 months of clopidogrel therapy in addition to aspirin. The primary end point was a composite of death of any cause, myocardial infarction, or cerebrovascular accident. The cumulative risk of the primary outcome at 2 years was 10.1% with 24-month dual-antiplatelet therapy compared with 10.0% with 6-month dual-antiplatelet therapy (hazard ratio, 0.98; 95% confidence interval, 0.74–1.29; P=0.91). The individual risks of death, myocardial infarction, cerebrovascular accident, or stent thrombosis did not differ between the study groups; however, there was a consistently greater risk of hemorrhage in the 24-month clopidogrel group according to all prespecified bleeding definitions, including the recently proposed Bleeding Academic Research Consortium classification. 
 
 
Conclusions
A regimen of 24 months of clopidogrel therapy in patients who had received a balanced mixture of drug-eluting or bare-metal stents was not significantly more effective than a 6-month clopidogrel regimen in reducing the composite of death due to any cause, myocardial infarction, or cerebrovascular accident. 







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Prepared by: Houssam Nahhas






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