In patients with drug-eluting stents, extended use of clopidogrel plus aspirin may not be better
MONDAY, March 15 (HealthDay News) -- In patients who have received drug-eluting stents, dual antiplatelet therapy longer than 12 months is no more effective than aspirin monotherapy in decreasing the rate of heart attack or death from cardiovascular causes, according to a study published online March 15 in the New England Journal of Medicine The study was released to coincide with the Annual Scientific Session of the American College of Cardiology, held from March 14 to 16 in Atlanta.
Seung-Jung Park, M.D., of the University of Ulsan College of Medicine in Seoul, South Korea, and colleagues randomized 2,701 individuals who had received drug-eluting stents but hadn't experienced any major adverse cardiac or cerebrovascular events or major bleeding for the last 12 months to clopidogrel plus aspirin or aspirin monotherapy.
The researchers found that the cumulative risk of the primary end point (composite of myocardial infarction or death from cardiac causes) at two years was 1.8 percent with clopidogrel plus aspirin and 1.2 percent with aspirin monotherapy. The individual risks for heart attack, repeat revascularization, stroke, major bleeding, stent thrombosis and death from any cause did not differ significantly between the two groups. However, the researchers noted a non-significant increase in the composite risk of heart attack, stroke or death from any cause, as well as in the composite risk of heart attack, stroke or death from cardiac causes in those taking aspirin plus clopidogrel as compared to those on aspirin monotherapy.
"In conclusion, in our study, extended use of dual antiplatelet therapy, for more than 12 months, was not significantly more effective than aspirin monotherapy in reducing the risk of myocardial infarction or death from cardiac causes among patients who had received drug-eluting stents and had not subsequently had ischemic or bleeding events," the authors write. "Larger clinical trials will be necessary."
Several authors reported financial relationships with pharmaceutical and medical technology companies, including Boston Scientific, Cordis and Medtronic.