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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDual antiplatelet therapy (aspirin plus clopidogrel) did not appear to be more effective than aspirin alone in reducing the rate of cardiac death or myocardial infarction, according to pooled data from the Correlation of Clopidogrel Therapy Discontinuation in Real-World Patients Treated with Drug-Eluting Stent Implantation and Late Coronary Artery Thrombotic Events [REAL-LATE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00484926\u0026amp;atom=%2Fspmdc%2F10%2F2%2F15.atom\u0022\u003ENCT00484926\u003C\/a\u003E] and Evaluation of the Long-Term Safety After Zotarolimus-Eluting Stent, Sirolimous-Eluting Stent, or Paclitaxel-Eluting Stent Implantation for Coronary Lesions Late Coronary Arterial Events [ZEST-LATE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00590174\u0026amp;atom=%2Fspmdc%2F10%2F2%2F15.atom\u0022\u003ENCT00590174\u003C\/a\u003E] Trials. The two trials were merged due to their design similarity and slow enrollment.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EDual antiplatelet therapy (aspirin plus clopidogrel) did not appear to be more effective than aspirin alone in reducing the rate of cardiac death or myocardial infarction (MI), according to pooled data from the Correlation of Clopidogrel Therapy Discontinuation in Real-World Patients Treated with Drug-Eluting Stent Implantation and Late Coronary Artery Thrombotic Events (REAL-LATE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00484926\u0026amp;atom=%2Fspmdc%2F10%2F2%2F15.atom\u0022\u003ENCT00484926\u003C\/a\u003E) and Evaluation of the Long-Term Safety After Zotarolimus-Eluting Stent, Sirolimous-Eluting Stent, or Paclitaxel-Eluting Stent Implantation for Coronary Lesions Late Coronary Arterial Events (ZEST-LATE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00590174\u0026amp;atom=%2Fspmdc%2F10%2F2%2F15.atom\u0022\u003ENCT00590174\u003C\/a\u003E) Trials. The two trials were merged due to their design similarity and slow enrollment, and merged results were presented by Seung-Jung Park, MD, PhD, Asan Medical Center, Seoul, Korea.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ECurrent guidelines recommend the use of clopidogrel 75 mg daily for at least 12 months post-drug-eluting stent (DES) implantation, provided that the patient is not at high risk of bleeding. While early discontinuation of dual antiplatelet therapy is associated with a higher risk of late stent thrombosis in patients with DES, there is no consistent data regarding the appropriate treatment duration and the long-term outcomes that are associated with dual antiplatelet therapy in these patients. The merged data analysis by Dr. Park and colleagues sought to compare antiplatelet strategies in patients on dual antiplatelet therapy who were free of major adverse cardiovascular events (MACEs) and major bleeding for at least 12 months post-DES implantation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EPatients in these two open-label trials were randomized to receive either clopidogrel 75 mg daily plus low-dose aspirin (100 to 200 mg daily; n=1357) or low-dose aspirin alone (n=1344). Patients were well matched at baseline. However, the REAL-LATE participants included a broader population that did not limit clinical or lesion characteristics. Exclusion criteria across the studies included contraindications to antiplatelet drugs, concomitant vascular disease or other indications that required the long-term use of clopidogrel, noncardiac comorbidities that limited life expectancy to \u0026lt;1 year, and participation in another drug or coronary device study. Follow-up evaluations were performed every 6 months, and the median duration of follow-up was 19.2 months. The primary endpoint was the first occurrence of MI or death from cardiac causes postrandomization. The secondary endpoints included major bleeding, as defined by Thrombolysis in Myocardial infarction (MI) criteria; a composite of death or MI; a composite of death, MI, or stroke; a composite of cardiac death, MI, or stroke; or individual components, including death, MI, stroke of any cause, definite stent thrombosis, or repeat revascularization.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe risk of cardiac death or MI was similar for both groups (1.8% for dual therapy vs 1.2% for monotherapy; p=0.17). The composite risk of MI, stroke, or death from any cause was slightly higher in the dual therapy group (HR, 1.73; 95% CI, 0.99 to 3.00; p=0.051), as was the composite risk of MI, stroke, or death from cardiac causes (HR, 1.84; 95% CI, 0.99 to 3.45; p=0.06). However, neither of these increases reached statistical significance. The risks that were associated with the individual components of the secondary endpoint were similar in both groups. Overall, the use of dual antiplatelet therapy beyond 12 months post-DES implantation did not significantly reduce the risk of MI or death from cardiac causes compared with aspirin monotherapy.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EDr. Park concluded that this study had insufficient statistical power to determine the safety of clopidogrel discontinuation after 12 months. Therefore, larger clinical trials with a longer-term follow-up are needed to evaluate the risk of clopidogrel discontinuation.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2010 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EFurther Reading\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-10.2.15.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPark\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003ES-J\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EDuration of Dual Antiplatelet Therapy after Implantation of Drug-Eluting Stents\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EN Eng J Med\u003C\/abbr\u003E 15 Apr \u003Cspan class=\u0022cit-pub-date\u0022\u003E2010\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E362(15)\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E1374\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E1382\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DN%2BEng%2BJ%2BMed%26rft.volume%253D36215%26rft.spage%253D1374%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/10\/2\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmt7q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}