POEMs

Patient-Oriented Evidence That Matters

One Month of Dual Antiplatelet Therapy Followed by Clopidogrel Alone Is Superior to 12 Months of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention

 

Am Fam Physician. 2019 Dec 15;100(12):online.

Clinical Question

Is one month of dual antiplatelet therapy followed by clopidogrel (Plavix) monotherapy noninferior or superior to 12 months of dual antiplatelet therapy in adults undergoing percutaneous coronary intervention?

Bottom Line

This study found that one month of dual antiplatelet therapy (aspirin plus clopidogrel or prasugrel [Effient]) followed by clopidogrel monotherapy for up to five years is both noninferior and superior to 12 months of dual antiplatelet therapy followed by aspirin for up to five years for reducing the risk of adverse cardiovascular outcomes and major bleeding complications in adults undergoing successful percutaneous coronary intervention with a drug-eluting stent. Another study of similar patients in the same journal also reported noninferior rates of major adverse cardiovascular events and significantly fewer adverse bleeding events after three months of dual antiplatelet therapy followed by P2Y12 inhibitor monotherapy (e.g., clopidogrel, prasugrel, ticagrelor [Brilinta]) compared with 12 months of dual antiplatelet therapy. (Level of Evidence = 1b)

Synopsis

The optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stents remains uncertain, especially because the mortality associated with a bleeding event is comparable with cardiovascular mortality following acute myocardial infarction. The investigators identified consenting adults (N = 3,045) who underwent successful percutaneous coronary intervention with a cobalt-chromium everolimus–eluting stent. Before hospital discharge, eligible patients randomly received (concealed allocation assignment) one month of dual antiplatelet therapy with either aspirin (81 to 200 mg per day) and clopidogrel (75 mg per day) or aspirin and prasugrel (3.75 mg per day) followed by clopidogrel monotherapy for up to five years, or dual antiplatelet therapy with aspirin and clopidogrel for up to 12 months, followed by aspirin monotherapy for up to five years.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

 

 

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Oct 15, 2020

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article