Mortality risks climb in stent patients when long-term Plavix is stopped

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Dec. 6 – To discontinue clopidogrel, or Plavix, after extended use following stent implantation is associated with an increased mortality risk, according to a study published in the November issue of the American Heart Journal.

P. Michael Ho, MD, PhD, FACC, of the VA Medical Center and the University of Colorado Health Sciences Center, both in Denver, and colleagues, researched the association between clopidogrel use and long-term outcomes after stent implantation for acute coronary syndromes (ACS) in clinical practice.

The retrospective cohort study included patients with ACS receiving drug-eluting stent (DES) or bare-metal stent (BMS) who were discharged from all Veterans Health Administration hospitals from 2003 to 2004. Clopidogrel use was assessed by pharmacy dispensing data. All patients received a median follow-up of 538 days.

Of the 1,455 patients with ACS, 65.8 percent received BMS and 34.2 percent received DES. The median number of days of clopidogrel use was 299.

In multivariable analysis, clopidogrel discontinuation was associated with higher all-cause mortality. The findings were consistent for patients receiving BMS or DES and for the outcomes of acute myocardial infarction (AMI) and mortality. When follow-up was divided into six-month intervals, the link between clopidogrel discontinuation and higher mortality remained consistent up to 18 months after hospital discharge. In a secondary analysis of patients who were event-free at six months, clopidogrel discontinuation was associated with higher risk for AMI among patients receiving DES compared with BMS.

The researchers said that “clinical trials are urgently needed to define the optimal duration of clopidogrel therapy after stent implantation for ACS.”