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(Circulation. 2009;119:1634-1642.)
© 2009 American Heart Association, Inc.

Interventional Cardiology

Safety of Short-Term Discontinuation of Antiplatelet Therapy in Patients With Drug-Eluting Stents

Mark J. Eisenberg, MD, MPH; Pierre R. Richard, BSc; Danielle Libersan, PhD; Kristian B. Filion, MSc

From the Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University (M.J.E., P.R.R., D.L., K.B.F.), Department of Epidemiology, Biostatistics, and Occupational Health (M.J.E., K.B.F.), McGill University, and Division of Clinical Epidemiology, McGill University Health Center (K.B.F.), Montreal, Quebec, Canada.

Correspondence to Mark J. Eisenberg, MD, MPH, Professor of Medicine, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Cote Ste Catherine Rd, Suite A-118, Montreal, Quebec, Canada H3T 1E2. E-mail mark.eisenberg{at}mcgill.ca

Received August 8, 2008; accepted January 13, 2009.

Background— Antiplatelet therapy is often discontinued in patients with drug-eluting stents who are undergoing surgical procedures. However, discontinuation of antiplatelet therapy is an important risk factor for late stent thrombosis. Our objective was to examine the safety of short-term discontinuation of antiplatelet therapy.

Methods and Results— We systematically searched Medline for reported cases of late stent thrombosis and very late stent thrombosis published between January 2001 and July 2008. We restricted our search to Academic Research Consortium–defined definite cases. We identified 161 cases of late stent thrombosis or very late stent thrombosis from 84 articles (79 from case reports, 61 from registries, and 21 from randomized clinical trials). Patients had a mean age of 58.4±13.4 years, and 88% were male. A total of 19 cases occurred in patients who were receiving dual antiplatelet therapy at the time of the event. If patients stopped both antiplatelet agents simultaneously, the median time to event was 7 days. If patients had previously stopped a thienopyridine with no ill effect and subsequently stopped acetylsalicylic acid, the median time to event was also 7 days from the time of acetylsalicylic acid cessation. If the thienopyridine was stopped but acetylsalicylic acid was maintained, the median time to event was 122 days. Among the 48 patients who stopped both agents, 36 cases (75%) occurred within 10 days. Among the 94 patients who discontinued a thienopyridine but continued acetylsalicylic acid, only 6 cases (6%) occurred within 10 days.

Conclusion— If acetylsalicylic acid therapy is maintained, short-term discontinuation of a thienopyridine may be relatively safe in patients with drug-eluting stents.

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CLINICAL PERSPECTIVE

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Clinical Summaries
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