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WikiDoc Resources for Stent thrombosis relationship to discontinuation of antiplatelet therapy
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Incidence of stent thrombosis (ST) of drug eluting stents (DES) in relation to antiplatelet medication use

Incidence of ST on dual antiplatelet therapy.

In a prospective study of 2229 patients with DES 83% ST occurred in patients who were on dual antiplatelet therapy. ref1.

Incidence of early ST while on dual antiplatelet therapy

• This category would include incidence of acute and subacute ST

In a study of 1911 patients on dual antiplatelet therapy a ST rate of 0.05% was reported. (one patient) ref2.

In the real world setting in an observational study involving 15157 patients with SES rate of acute ST was 0.13%. ref3.

A rate of 0.15 % subacute ST was reported in a study of 1911 patients who were treated with aspirin, clopidogrel and on the treating physicians discretion - GP2b3a ref1.

Incidence of late ST while on dual antiplatelet therapy

• This category would include incidence of late and very late ST

In a cohort of 2006 patients with PES and SES up to a mean follow-up of 15 months with a follow up rate of 98% of the patients, no ST occurred while patients were on dual antiplatelet therapy ref4.

A study involving 1911 patients who had DES, showed a (??late) incidence of 0.2% of ST while on dual antiplatelet therapy ref2.

Incidence of ST of DES while on single antiplatelet therapy.

Incidence of early ST of DES while on single antiplatelet therapy.

• This category would include acute and subacute ST while on single antiplatelet therapy.
• This is an uncommon category as most patients are on dual antiplatelet medications.
  • How ever it has been suggested that those patients who are suboptimally loaded with dual antiplatelet therapy and who also receive bivalirudin, may be at an increased risk of ST during the waning of the effect of bivalirudin and until dual antiplatelet effects becomes adequate.
  • Another scenario is the patient who is intolerant to one antiplatelet medication. This again is a very uncommon situation, as hospitals use aspirin desensitization and clopidogrel desensitization.

Incidence of late ST of DES while on single antiplatelet therapy

• This category would include late ST and very late ST

Overall the incidence of late ST in patients who presented on aspirin monotherapy was 0.25%. How ever no data was reported as to the proportion of patients who were on aspirin monotherpay at that time. 60% of the patients who presented with late ST and were on aspirin monotherpay after 6 months of the procedure. It is possible that the majority of the patients may have been on aspirin monotherapy at that time, yielding an incidence of ST for this group of 0.25% ref1.

In a study involving 1911 patients who had DES 0.15% of patients who presented with late ST were on one antiplatelet therapy. How ever it is not clear as to the number of patients in the whole cohort who were on single antiplatelet therapy ref1. In one study, hazard ratio for late ST on premature discontinuation of antiplatelet therapy was 57.13 (14.84 - 219.96) ref1.

Incidence of ST of DES while on no antiplatelet therapy

Incidence of early ST while on no antiplatelet therapy

This is an unlikely scenario in the current environment.

Incidence of late ST while on no antiplatelet therapy

On long term follow up to 19.4 months, 121 patients with DES had complete interruption of antiplatelet therapy with a ST rate of 3.3 % in that group. (this represented an overall risk of 0.2 % when applied to the whole study population.) In the same group the rate of ST when both antiplatelet therapies were stopped within 6 months of stent implantation was 9%. ref2.

Two patients presented with ST who were 343 and 335 days following DES implantation. They had ceased dual antiplatelet therapy within 14 days of ST . Data of other patients who had a DES with no antiplatelet cover for the same duration was not available. ref5.

One patient had ST following discontinuation of both antiplatelet medications. ? DES or BMS ? late or very late?( awaiting further information) ref6.

Back to main page Coronary stent thrombosis

References

1. Ref1 Iakovou, I, Schmidt, T, Bonizzoni, E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 2005; 293:2126
2. Ref2 Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, Hong MK, Kim JJ, Park SJ. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol. 2006;98:352–356.
3. Ref3 Urban, P, Gershlick, AH, Guagliumi, G, et al. Safety of coronary sirolimus-eluting stents in daily clinical practice: one-year follow-up of the e-Cypher registry. Circulation 2006; 113:1434.
4. Ref4 Ong, AT, McFadden, EP, Regar, E, et al. Late angiographic stent thrombosis (LAST) events with drug-eluting stents. J Am Coll Cardiol 2005; 45:2088
5. Ref5 McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, Suddath WO, Weissman NJ, Torguson R, Kent KM, Pichard AD, Satler nLF, Waksman R, Serruys PW. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet. 2004;364: 1519–1521.
6. Ref6 Wilson SH; Fasseas P; Orford JL; Lennon RJ; Horlocker T; Charnoff NE; Melby S; Berger PB Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting. J Am Coll Cardiol 2003 Jul 16;42(2):234-40

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Guidelines / Policies / Government Resources (FDA/CDC) Regarding Stent thrombosis relationship to discontinuation of antiplatelet therapy	US National Guidelines Clearinghouse on Stent thrombosis relationship to discontinuation of antiplatelet therapy • NICE Guidance on Stent thrombosis relationship to discontinuation of antiplatelet therapy • NHS PRODIGY Guidance • FDA on Stent thrombosis relationship to discontinuation of antiplatelet therapy • CDC on Stent thrombosis relationship to discontinuation of antiplatelet therapy
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Genetics, Pharmacogenomics, and Proteinomics of Stent thrombosis relationship to discontinuation of antiplatelet therapy	Genetics of Stent thrombosis relationship to discontinuation of antiplatelet therapy • Pharmacogenomics of Stent thrombosis relationship to discontinuation of antiplatelet therapy • Proteomics of Stent thrombosis relationship to discontinuation of antiplatelet therapy
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Healthcare Provider Resources on Stent thrombosis relationship to discontinuation of antiplatelet therapy	Symptoms of Stent thrombosis relationship to discontinuation of antiplatelet therapy • Causes & Risk Factors for Stent thrombosis relationship to discontinuation of antiplatelet therapy • Diagnostic studies for Stent thrombosis relationship to discontinuation of antiplatelet therapy • Treatment of Stent thrombosis relationship to discontinuation of antiplatelet therapy
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Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .