Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents.
Publication/Presentation Date
12-4-2014
Abstract
BACKGROUND: Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain.
METHODS: Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed. After 12 months of treatment with a thienopyridine drug (clopidogrel or prasugrel) and aspirin, patients were randomly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months; all patients continued receiving aspirin. The coprimary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial infarction, or stroke) during the period from 12 to 30 months. The primary safety end point was moderate or severe bleeding.
RESULTS: A total of 9961 patients were randomly assigned to continue thienopyridine treatment or to receive placebo. Continued treatment with thienopyridine, as compared with placebo, reduced the rates of stent thrombosis (0.4% vs. 1.4%; hazard ratio, 0.29 [95% confidence interval {CI}, 0.17 to 0.48]; P
CONCLUSIONS: Dual antiplatelet therapy beyond 1 year after placement of a drug-eluting stent, as compared with aspirin therapy alone, significantly reduced the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events but was associated with an increased risk of bleeding. (Funded by a consortium of eight device and drug manufacturers and others; DAPT ClinicalTrials.gov number, NCT00977938.).
Volume
371
Issue
23
First Page
2155
Last Page
2166
ISSN
1533-4406
Published In/Presented At
Mauri, L., Kereiakes, D. J., Yeh, R. W., Driscoll-Shempp, P., Cutlip, D. E., Steg, P. G., Normand, S. L., Braunwald, E., Wiviott, S. D., Cohen, D. J., Holmes, D. R., Jr, Krucoff, M. W., Hermiller, J., Dauerman, H. L., Simon, D. I., Kandzari, D. E., Garratt, K. N., Lee, D. P., Pow, T. K., Ver Lee, P., … DAPT Study Investigators (2014). Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. The New England journal of medicine, 371(23), 2155–2166. https://doi.org/10.1056/NEJMoa1409312
Disciplines
Medicine and Health Sciences
PubMedID
25399658
Department(s)
Department of Medicine
Document Type
Article