Stent thrombosis after drug-eluting stent implantation: incidence, timing, and relation to discontinuation of clopidogrel therapy over a 4-year period

• Published in: European heart journal 2009-11, Vol.30 (22), p.2714-2721
• Main Authors: Schulz, Stefanie, Schuster, Tibor, Mehilli, Julinda, Byrne, Robert A., Ellert, Julia, Massberg, Steffen, Goedel, Julia, Bruskina, Olga, Ulm, Kurt, Schömig, Albert, Kastrati, Adnan
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood Vessel Prosthesis; Cardiology. Vascular system; Clopidogrel; Coronary Angiography; Drug-eluting stent; Drug-Eluting Stents; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - etiology; Platelet Aggregation Inhibitors - administration & dosage; Prospective Studies; Stent thrombosis; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehp275

Aims To assess the incidence, timing, and relation of drug-eluting stent (DES) thrombosis to discontinuation of clopidogrel therapy. Methods and results This prospective observational cohort study included 6816 consecutive patients that underwent successful DES implantation. Primary endpoint was definite stent thrombosis (ST). During 4 years of follow-up, definite ST was observed in 73 patients, corresponding to a cumulative incidence of 1.2%. Cumulative incidence of ST at 30 days was 0.5 and 0.8% at 1 year, respectively. Discontinuation of clopidogrel therapy was significantly associated with ST only in the first 6 months after the procedure (P < 0.001). During that period, the median time interval from clopidogrel discontinuation to ST was 9 days [interquartile range (IQR) 5.5–22.5] while thereafter it was 104.3 days (IQR 7.4–294.8). Conclusion The 4 year incidence of ST after DES implantation is low. A relevant number of ST occur early after discontinuation of clopidogrel therapy. The dependence of ST on discontinuation of clopidogrel therapy seems to be mostly confined to the first 6 months after DES implantation. However, specifically designed randomized studies are required to establish the optimal length of clopidogrel therapy after DES implantation.