Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation: A Randomized, Controlled Trial

Study Questions:

What is the optimal duration of antiplatelet therapy in patients treated with drug-eluting stents (DES)?

Methods:

DES-LATE (Duration of Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents) was a multicenter, open-label, randomized comparison trial in 24 clinical centers in Korea. A total of 5,045 patients who received DES and were free of major adverse cardiovascular events and major bleeding for at least 12 months after stent placement were randomized to receive aspirin alone (n = 2,514) or clopidogrel plus aspirin (n = 2,531). The primary endpoint was a composite of death resulting from cardiac causes, myocardial infarction, or stroke 24 months after randomization.

Results:

At 24 months, there was no difference in the primary endpoint (2.4% vs. 2.6%, hazard ratio, 0.94; 95% confidence interval, 0.66-1.35; p = 0.75). The two groups did not differ significantly in terms of the individual risks of death resulting from any cause, myocardial infarction, stent thrombosis, or stroke. There was no difference in the incidence of major bleeding (1.1% vs. 1.4%, hazard ratio, 0.71; 95% confidence interval, 0.42-1.20; p = 0.20).

Conclusions:

The investigators concluded that continuation of clopidogrel for 2 years was not associated with a reduction in thrombotic events in patients treated with DES.

Perspective:

The optimal duration of antiplatelet therapy in patients treated with contemporary DES is unknown, and it is possible that shorter duration of antiplatelet therapy may suffice for a large number of patients. This study assessed the impact of prolonging antiplatelet therapy beyond 1 year, and found no reduction in ischemic events with this approach. This study adds to the growing evidence suggesting that there is no role for routine dual antiplatelet therapy beyond 1 year in patients undergoing percutaneous coronary intervention with DES.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Myocardial Infarction, Stroke, Republic of Korea, Platelet Aggregation Inhibitors, Thrombosis, Drug-Eluting Stents, Ticlopidine, Percutaneous Coronary Intervention


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