Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation

Ignacio Ferreira-González, Josep R. Marsal, Aida Ribera, Gaietà Permanyer-Miralda, Bruno García-Del Blanco, Gerard Martí, Purificación Cascant, Victoria Martín-Yuste, Salvatore Brugaletta, Manuel Sabaté, Fernando Alfonso, Mari L. Capote, Jose M. De La Torre, Marta Ruíz-Lera, Dario Sanmiguel, Mérida Cárdenas, Beth Pujol, Jose A. Baz, Andrés Iñiguez, Ramiro TrilloOmar González-Béjar, Juan Casanova, Joaquín Sánchez-Gila, David García-Dorado

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Abstract

Background-: Predictors of antiplatelet therapy discontinuation (ATD) during the first year after drug-eluting stent implantation are poorly known. Methods and results-: This was a prospective study with 3-, 6-, 9-, and 12-month follow-up of patients receiving at least 1 drug-eluting stent between January and April 2008 in 29 hospitals. Individual-and hospital-level predictors of ATD were assessed by hierarchical-multinomial regression analysis. ATD could be assessed in 1622 candidates for follow-up (82.5%). A total of 234 patients (14.4%) interrupted at least 1 antiplatelet therapy drug, predominantly clopidogrel (n=182, 11.8%). Bleeding events or invasive procedures led to ATD in 109 patients. This was predicted by renal impairment (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.48 to 5.34), prior major hemorrhage (OR 3.77, 95% CI 1.41 to 10.03), and peripheral arterial disease (OR 1.78, 95% CI 1.01 to 3.15). Medical decisions led to ATD in 70 patients; this was predicted by long-term use of anticoagulant therapy (OR 3.88, 95% CI 1.26 to 11.98), undergoing the procedure in a private hospital (OR 13.3, 95% CI 1.69 to 105), and not receiving instructions about medication (OR 2.8, 95% CI 1.23 to 6.36). Thirty-nine patients interrupted ATD on their own initiative, mainly immigrants (OR 3.78, 95% CI 1.2 to 11.98) and consumers of psychotropic drugs (OR 2.58, 95% CI 1.3 to 5.12). Conclusions-: ATD during the first year after drug-eluting stent implantation is based mainly on patient decision or a medical decision not associated with major bleeding events or major surgical procedures. Individual-and hospital-level variables are important to predict ATD. © 2010 American Heart Association, Inc.
Original languageEnglish
Pages (from-to)1017-1025
JournalCirculation
Volume122
Issue number10
DOIs
Publication statusPublished - 7 Sep 2010

Keywords

  • antiplatelet drugs
  • drug-eluting stents
  • medication adherence

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    Ferreira-González, I., Marsal, J. R., Ribera, A., Permanyer-Miralda, G., García-Del Blanco, B., Martí, G., Cascant, P., Martín-Yuste, V., Brugaletta, S., Sabaté, M., Alfonso, F., Capote, M. L., De La Torre, J. M., Ruíz-Lera, M., Sanmiguel, D., Cárdenas, M., Pujol, B., Baz, J. A., Iñiguez, A., ... García-Dorado, D. (2010). Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation. Circulation, 122(10), 1017-1025. https://doi.org/10.1161/CIRCULATIONAHA.110.938290