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

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.

journal_name

Circulation

journal_title

Circulation

authors

Ferreira-González I,Marsal JR,Ribera A,Permanyer-Miralda G,García-Del Blanco B,Martí G,Cascant P,Martín-Yuste V,Brugaletta S,Sabaté M,Alfonso F,Capote ML,De La Torre JM,Ruíz-Lera M,Sanmiguel D,Cárdenas M,Pujol B,Baz JA

doi

10.1161/CIRCULATIONAHA.110.938290

subject

Has Abstract

pub_date

2010-09-07 00:00:00

pages

1017-25

issue

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.110.938290

journal_volume

122

pub_type

临床试验,杂志文章

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