Longer Use of Clopidogrel Explored

 

December 7, 2006

Taking anti-platelet medication longer than current recommendations may lower heart attack or death risks for patients with drug-eluting stents, according to a study funded by the Agency for Healthcare Research and Quality and published this week in the online version of JAMA.

Clopidogrel is currently recommended for three to six months after placement of DES. But the new observational study by AHRQ's DEcIDE Research Center at Duke University suggests the drug reduces risks of heart attack or death for at least two years in some patients, Newswire reports.

"This study suggests that patients and their physicians should consider extending the period of use of this therapy while monitoring its effects very carefully,'' said AHRQ Director Carolyn M. Clancy, MD. "Further research will help us understand fully the balance of risks and benefits of extended use of anti- platelet therapy in people who have drug-eluting stents."

How long clopidogrel may be needed, however, remains uncertain.

The Duke study included 4,666 patients who received drug-eluting stents or bare metal stents during a five-year period. Of those, 3,609 were defined as "event free,'' meaning they had not died, had heart attacks or undergone additional procedures to open coronary arteries for at least six months since stent placement. Researchers then checked those patients' use of clopidogrel and their health status through September 2006. The study concluded:

-- Among drug-eluting stent patients who were event free at six months, those who reported clopidogrel use were significantly less likely to die during the next 18 months than those who did not use the drug (a 2 percent death rate vs. a 5.3 percent death rate). These patients were also less likely to either die or have a heart attack (3.1 percent vs. 7.2 percent).

-- Among patients who had been event free for a full year, those who reported clopidogrel use at 12 months were similarly less likely than those not taking clopidogrel to die during the next 12 months (0 percent vs. 3.5 percent), and less likely to either die or have a heart attack (0 percent vs. 4.5 percent).

For more information about DEcIDE and the EHC program, visit http://www.effectivehealthcare.ahrq.gov.