Late coronary thrombosis after drug-eluting stent: stent vs patient-driven prescription of aspirin-clopidogrel combination

Introduction Combination therapy with a thienopyridine (ticlopidine or clopidogrel) plus aspirin has emerged as standard care after percutaneous coronary intervention (PCI) with stent implantation. However, the optimal duration of this combined treatment after PCI, originally given for one month after stenting, remains uncertain. Drug-eluting stents (DES) (2-4) reduce intimal hyperplasia and restenosis, but also inhibit stent reendothelization, making the vascular surface more thrombogenic for longer time periods. This has reproposed the issue of the optimal duration of aspirin-clopidogrel therapy. Stent thrombosis with DES occurs with a rate of =1% at 9 months (2-4). However, its late occurrence during post-marketing surveillance, and the extreme severity of ensuing clinical consequences recently prompted the American Food and Drug Administration to release a public warning on this issue. . . .