Browse > Article

Effect of Triple Compared to Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Percutaneous Coronary Intervention  

Ye, Kyong-Nam (Graduate School of Clinical Pharmacy, Sookmyung Wuomen's University)
Kim, Jeong-Tae (Kyunghee University Hospital at Gangdong)
Lee, Suk-Hyang (College of Pharmacy, Ajou University)
Publication Information
Korean Journal of Clinical Pharmacy / v.22, no.2, 2012 , pp. 113-122 More about this Journal
Abstract
ACC/AHA/SCAI Guideline recommends for administration dual antiplatelet therapy after drug-eluting stent (DES) to prevent restenosis and stent thrombosis in patients with percutaneous coronary intervention (PCI). Recently triple antiplatelet therapy including cilostazol is known to reduce restenosis and stent thrombosis significantly after DES implantation. However, there is lack of data providing the efficacy of triple antiplatelet therapy. The purpose of this study is to evaluate the clinical effects of the triple therapy after DES implantation compared with the dual therapy. This retrospective study collected data from medical charts of 251 patients who received DES implantation between Jul 2006 and Jun 2008. They received either dual antiplatelet therapy (N = 154 clopidogrel and aspirin; Dual group) or triple antiplatelet therapy (N = 97 cliostazol, clopidogrel and aspirin; Triple group). Major adverse cardiac event rates (MACE, included total death, myocardial infarction, target lesion revascularization) at 12 months, 24 months, stent thrombosis, rates of bleeding complications and adverse drug reactions were compared between these two groups. Compared with the dual group, the triple group had a similar incidence of the MACE rates at 24months (12.3% vs. 12.4%, p = 0.99). There is no difference in overall stent thrombosis between two groups (Dual group 2.6% vs. Triple group 4.1%, p = 0.5). Subgroup analysis showed that diabetic patients got more benefit in reducing MACE rates but, there is no statistical difference. Bleeding complications and adverse drug effects were not different significantly. As compared with dual antiplatelet therapy, triple antiplatelet therapy did not reduce the 12-months, 24-months MACE rates and stent thrombosis. Bleeding complications and adverse drug effects were not different.
Keywords
Percutaneous Coronary Intervention (PCI); Drug Eluting Stent (DES); Antiplatelet therapy; Clopidogrel; Cilostazol; Aspirin 249 words;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Rosamond W, Flegal K, Furie K, et al., Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008; 117: e25-e146.   DOI   ScienceOn
2 Lloyd-Jones D, Adams RJ, Brown TM, et al., Executive Summary: Heart Disease and Stroke Statistics-2010 Update: A Report From the American Heart Association. Circulation 2010; 121: e46-e215.   DOI
3 통계청. 사망원인통계 결과. 2009.
4 Serruys PW, de Jaegere P, Kiemeneij F, et al., A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994; 331: 489-495.   DOI   ScienceOn
5 Fischman D, Leon MB, Baim DS, et al., A randomized comparison of coronary stent placement and balloon angioplasty in treatment of coronary artery disease. N Engl J Med 1994; 331: 496-501.   DOI   ScienceOn
6 Stettler C, Wandel S, Allemann S, et al., Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007; 370: 937-48.   DOI   ScienceOn
7 Grines CL BR, Casey DE JR, Gardner TJ, et al., Prevention of premature discontinuation of Dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 2007; 115: 813-818.   DOI   ScienceOn
8 Stone GW ES, Colombo A, Dawkins KD, et al., Offsetting impact of thrombosis and restenosis on the occurrence of deathand myocardial infarction after paclitaxel-eluting and bare metal stent implantation. Circulation 2007; 115: 2842- 2847.   DOI   ScienceOn
9 Kushner F, Hand M, Smith JR S, et al., 2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/ AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2009; 54: 2205- 2241.   DOI   ScienceOn
10 Snoep JD HM, Eikenboom JC, van der Bom JG, et al., Clopidogrel nonresponsiveness in patients undergoing percutaneous coronary intervention with stenting: a systematic review and meta-analysis. Am Heart J 2007; 154: 221-231.   DOI   ScienceOn
11 Lev EI PR, Maresh KJ, Guthikonda S, et al., Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of Dual drug resistance. J Am Coll Cardiol 2006; 47: 27-33.   DOI   ScienceOn
12 Chen WH, Chenq X, Lee PY, et al., Aspirin resistance and adverse clinical events in patients with coronary artery disease. Am J Med 2007; 120: 631-635.   DOI   ScienceOn
13 Kim JY Yoon JH. Aspirin and clopidogrel resistance in drug eluting stent era. Korean Circ J 2007; 37: 135-147.   DOI   ScienceOn
14 Douglas Jr J, Holmes Jr D, Kereiakes D, et al., Coronary stent restenosis in patients treated with cilostazol. Circulation 2005; 112: 2826-2832.   DOI   ScienceOn
15 Lee S, Park S, Hong M, et al., Comparison of cilostazol and clopidogrel after successful coronary stenting. Am J Cardiol 2005; 95: 859-862.   DOI   ScienceOn
16 Lee S, Park S, Kim Y, et al., Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients With Diabetes Mellitus: The DECLAREDIABETES Trial (A Randomized Comparison of Triple Antiplatelet Therapy With Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Diabetic Patients). J Am Coll Cardiol 2008; 51: 1181-1187.   DOI   ScienceOn
17 Kim J, Lee K, Shin M, et al., Cilostazol could ameliorate platelet responsiveness to clopidogrel in patients undergoing primary percutaneous coronary intervention. Circulation J 2007; 71: 1867-1872.   DOI   ScienceOn
18 Tsuchikane E, Fukuhara A, Kobayashi T, et al., Impact of cilostazol on restenosis after percutaneous coronary balloon angioplasty. Circulation 1999; 100: 21-26.   DOI   ScienceOn
19 Lee S, Park S, Hong M, et al., Triple Versus Dual Antiplatelet Therapy After Coronary Stenting: Impact on Stent Thrombosis. J Am Coll Cardiol 2005; 46: 1833-1837.   DOI   ScienceOn
20 Spaulding C, Daemen J, Boersma E, et al., A pooled analysis of data comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 2007; 356: 989-997.   DOI   ScienceOn
21 Chesebro J, Knatterud G, Roberts R, et al., Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 1987; 76: 142-54   DOI   ScienceOn
22 Gawaz M, Neumann F, Ott I, et al., Platelet function in acute myocardial infarction treated with direct angioplasty. Circulation 1996; 93: 229-237.   DOI   ScienceOn
23 Park D, Park S, Park K, et al., Frequency of and risk factors forstent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol 2006; 98: 352-6.   DOI   ScienceOn
24 Park S, Lee C, Kim H, et al., Comparison of cilostazol versus ticlopidine therapy after stent implantation. Am J Cardiol 1999; 84: 511-4.   DOI   ScienceOn
25 Lee S, Park S, Kim Y, et al., Comparison of Triple versus Duala ntiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long trial). Am J Cardiol 2007; 100: 1103-8.   DOI   ScienceOn
26 $Micromedex{(R)}$1.0 (Healthcare Series). www.thomsonhc. com.
27 Chen K, Rha S, Li Y, et al., Triple versus Dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Circulation 2009; 119: 3207-3214.   DOI   ScienceOn
28 Park K-H, Jeong MH, Lee MG, et al., Efficacy of Triple Anti-Platelet Therapy Including Cilostazol in Acute Myocardial Infarction Patients Undergoing Drug-Eluting Stent Implantation. Korean Circ J 2009; 39: 190-7.   DOI   ScienceOn
29 금동성, 김무현, 백정환, et al., 약물용출 스텐트 삽입 후 추 가적 Cilostazol 투여의 임상적 효과. Korean Circ J 2009; 39: 21-5.   DOI