Patients with drug eluting stents do better on long term clopidogrel

doi:10.1136/bmj.334.7585.119-b

BMJ 2007;334:119 (20 January), doi:10.1136/bmj.334.7585.119-b

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Patients with drug eluting stents do better on long term clopidogrel

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Drug eluting stents work well in the short term,but longer follow-up of patients with these stents suggestedthey were associated with an increased risk of catastrophicrestenosis several years after a heart attack. No one knowsexactly why. It is possible, however, that antiplatelet agentssuch as clopidogrel could prevent restenosis if taken for longenough

In the absence of any clinical trials of extendedtreatment with clopidogrel, researchers looked for clues ina cohort of 4666 adults given drug eluting or bare metal stentsat one specialist centre in the US. They found a significantassociation between long term treatment with clopidogrel (sixor 12 months) and a lower risk of death over two years in patientswith drug eluting stents. Patients on extended treatment alsohad a lower risk of death or heart attack over two years. Longterm clopidogrel seemed to make no difference to patients withbare metal stents.

The authors used propensity scoring to adjustfor any systematic differences between patients who stoppedtreatment and those who continued with clopidogrel for six or12 months. But they and a linked editorial (pp 209-11) are stillcautious about the findings, which rely on patients rememberingaccurately the length of their treatment.