Mauri, Laura; Kereiakes, Dean J; Yeh, Robert W; Driscoll-Shempp, Priscilla; Cutlip, Donald E; Steg, P Gabriel; Normand, Sharon-Lise T; Braunwald, Eugene; Wiviott, Stephen D; Cohen, David J; Holmes, David R; Krucoff, Mitchell W; Hermiller, James; Dauerman, Harold L; Simon, Daniel I; Kandzari, David E; Garratt, Kirk N; Lee, David P; Pow, Thomas K; Ver Lee, Peter; ... (2014). Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. New England journal of medicine NEJM, 371(23), pp. 2155-2166. Massachusetts Medical Society MMS 10.1056/NEJMoa1409312 <http://dx.doi.org/10.1056/NEJMoa1409312Test>
BACKGROUND Dual antiplatelet therapy is recommended after coronary stenting to prevent thrombotic complications, yet the benefits and risks of treatment beyond 1 year are uncertain. METHODS Patients were enrolled after they had undergone a coronary stent procedure in which a drug-eluting stent was placed. After 12 months of treatment with a thienopyridine drug (clopidogrel or prasugrel) and aspirin, patients were randomly assigned to continue receiving thienopyridine treatment or to receive placebo for another 18 months; all patients continued receiving aspirin. The coprimary efficacy end points were stent thrombosis and major adverse cardiovascular and cerebrovascular events (a composite of death, myocardial infarction, or stroke) during the period from 12 to 30 months. The primary safety end point was moderate or severe bleeding. RESULTS A total of 9961 patients were randomly assigned to continue thienopyridine treatment or to receive placebo. Continued treatment with thienopyridine, as compared with placebo, reduced the rates of stent thrombosis (0.4% vs. 1.4%; hazard ratio, 0.29 [95% confidence interval {CI}, 0.17 to 0.48]; P
