All patients received aspirin, clopidogrel and other anti-clotting drugs during stenting. After stenting, all were prescribed aspirin 325 mg daily for one month and 81 mg indefinitely thereafter, plus clopidogrel 75 mg daily for one year, with subsequent clopidogrel prescription left up to physician discretion.
The researchers found that by six months, 10 percent of patients who were available for follow-up (133 out of 1,324) were no longer taking clopidogrel as prescribed. By one year, that number had edged up to 17.4 percent (233 out of 1,338) and by two years, to 33.2 percent (291 out of 877). However, of patients who were no longer taking clopidogrel at six months, nearly half were back on the medication at one- or two-year follow-up.
At one year, discontinuation of clopidogrel was attributed to doctors choice in 9.9 percent of patients, bleeding in 5.2 percent, surgery in 2.1 percent, rash or allergy in 1.7 percent and cost in 0.4 percent. In 39.5 percent of patients, the reason for discontinuation was unknown; 41.2 percent of patients discontinued clopidogrel simply because the recommended one-year dosing period had come to an end.
Researchers also evaluated clinical outcomes at various time points, dividing patients into those who continued taking clopidogrel and those who stopped. Patients who stopped taking clopidogrel by one year had a significantly higher risk of death when compared to those who continued taking the medication (4.8 percent vs. 1.4 percent, respectively, p=0.005); however, there was no significant difference in rates of cardiac death (1.1 percent vs. 0.2 percent, p=0.054), noncardiac death (2.7 percent vs. 1.0 percent, p=0.08) and unknown death (1.0 percent vs. 0.3 percent, p=0.16). The need for a repeat procedure to re-treat
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