Adverse events after stopping clopidogrel in post-acute coronary syndrome patients insights from a large integrated healthcare delivery system

P. Michael Ho, Thomas T. Tsai, Tracy Y. Wang, Susan M. Shetterly, Christina L. Clarke, Alan S. Go, Art Sedrakyan, John S. Rumsfeld, Eric D. Peterson, David J. Magid

Research output: Contribution to journalArticlepeer-review

Abstract

Background-A prior study from the Veterans Health Administration found a clustering of cardiovascular events after clopidogrel cessation. We sought to confirm and expand these findings. Methods and Results-This was a retrospective cohort study of 2017 patients with acute coronary syndrome discharged on clopidogrel from an integrated health care delivery system. Rates of all-cause mortality or acute myocardial infarction (MI) within 1 year after stopping clopidogrel were assessed among patients who did not have an event before stopping clopidogrel. Death/MI occurred in 4.3% (n=71) of patients. The rates of death/MI were 3.07, 1.62, 0.70, and 0.95 per 10 000 patient-days for the time intervals of 0 to 90, 91 to 180, 181 to 270, and 271 to 360 days after stopping clopidogrel. In multivariable analysis, the 0- to 90-day interval after stopping clopidogrel was associated with higher risk of death/MI (incidence rate ratio, 2.74;95% confidence interval, 1.69 to 4.44) compared with 91- to 360-day interval. There was a similar trend of increased events after stopping clopidogrel for various subgroups (women versus men, medical therapy versus percutaneous coronary intervention, stent type, and ≥6 months or <6 months of clopidogrel treatment). Among patients taking clopidogrel but stopping ACE inhibitor medications, the event rates were similar in the 0- to 90-day versus the 91- to 360-day interval (2.67 versus 2.91 per 10 000 patient-days; P=0.91). Conclusions-We observed a clustering of adverse events in the 0 to 90 days after stopping clopidogrel. This clustering of events was not present among patients stopping ACE inhibitors. These findings are consistent with a possible rebound platelet hyper-reactivity after stopping clopidogrel and additional platelet studies are needed to confirm this effect.

Original languageEnglish (US)
Pages (from-to)303-308
Number of pages6
JournalCirculation: Cardiovascular Quality and Outcomes
Volume3
Issue number3
DOIs
StatePublished - May 2010
Externally publishedYes

Keywords

  • Drugs
  • Epidemiology
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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