Incidence of side-effects of dual antiplatelet therapy with clopidogrel and aspirin after coronary stent implantation
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ORIGINAL ARTICLE
Incidence of side-effects of dual antiplatelet therapy with clopidogrel and aspirin after coronary stent implantation Kenji Ohkubo • Yoshio Kobayashi • Yoshitake Nakamura • Akira Miyazaki
Received: 29 March 2010 / Accepted: 26 July 2010 / Published online: 10 September 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract There is little information about the incidence of the side-effects of clopidogrel in Japanese patients undergoing coronary stent implantation. The present study included 334 consecutive patients who were given clopidogrel (75 mg daily) after coronary stent implantation. Aspirin (100 mg daily) was used indefinitely. Clopidogrel was prescribed for at least 4 weeks in patients with bare metal stents and indefinitely in those with drug-eluting stents (DES). The duration of clinical follow-up was 164.7 ± 139.0 days. Half of the patients underwent stenting because of acute myocardial infarction. DES were used in 38% of the patients. Definite early stent thrombosis occurred in one patient (0.31%). There was one definite late stent thrombosis (0.31%). Side-effects of the clopidogrel were observed in 16 patients (4.9%). Liver dysfunction occurred in seven patients (2.1%), skin rash in six (1.8%), and bleeding in three (0.9%). There was no neutropenia or thrombocytopenia. The results of this study show that prescribing clopidogrel as well as aspirin is a safe treatment for Japanese patients undergoing coronary stenting.
K. Ohkubo Y. Kobayashi (&) Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba 260-8677, Japan e-mail: [email protected] Y. Nakamura A. Miyazaki Division of Cardiology, Chiba Cardiovascular Center, Ichihara, Japan
Keywords
Antiplatelet therapy Stent Stent thrombosis
Introduction Clopidogrel plus aspirin has been the standard antiplatelet therapy after stenting in almost all countries [1, 2]. Clopidogrel was unavailable in Japan until May 2006 and was off-label for coronary stenting until October 2007. Thus there is little information about whether it is safe to use clopidogrel in Japanese patients undergoing coronary stent implantation and if so, to what extent. The present study evaluated the incidence of the side-effects of dual antiplatelet therapy with clopidogrel and aspirin in Japanese patients undergoing coronary stent implantation.
Methods Study patients Between November 2007 and August 2008, 504 patients underwent successful coronary stent implantation in two hospitals (Chiba University Hospital and Chiba Cardiovascular Center). Written informed consent was obtained before percutaneous coronary intervention. Stent implantation was performed according to standard techniques [3]. Intravascular ultrasound-guided stenting was performed in all lesions. In these, 91 patients were given ticlopidine because they had taken it without any side-effect. As a clinical investigation, 50 mg of clopidogrel was prescribed in 86 patients
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