Aspirin Alone Just as Good as Dual Antiplatelet Therapy Beyond 12 Months
SAN FRANCISCO, CA—Aspirin monotherapy results in similar rates of ischemic outcomes while decreasing bleeding compared with dual antiplatelet therapy beyond 12 months in stable patients who receive drug-eluting stents (DES). Results from the DES LATE trial were presented March 10, 2013, at the American College of Cardiology/i2 Scientific Session.
Cheol Whan Lee, MD, of Asan Medical Center (Seoul, South Korea), and colleagues looked at 5,045 patients from 25 centers in South Korea who had undergone DES implantation and been on dual therapy for at least 12 months. Patients were randomized to continued clopidogrel and aspirin or aspirin alone for another 2 years. All patients were free of any MACCE between DES implantation and randomization.
Adherence to assigned therapy at 1 and 2 years was 98.2% and 97.2%, respectively, in the aspirin-only arm and 88.6% and 79.4%, respectively, in the dual therapy arm.
At 2 years, the primary endpoint of cardiac death, MI, and stroke was similar between both groups, as were all secondary endpoints (table 1).
Table 1. Two-Year Outcomes
|
|
Aspirin Alone |
Dual Therapy |
P Value |
|
Cardiac Death, MI, Stroke |
2.4% |
2.6% |
0.75 |
|
Death |
1.4% |
2.0% |
0.12 |
|
MI |
1.2% |
0.8% |
0.23 |
|
Stroke |
0.9% |
0.9% |
0.98 |
|
Definite Stent Thrombosis |
0.5% |
0.3% |
0.34 |
|
TIMI Major Bleeding |
1.1% |
1.4% |
0.20 |
|
Repeat Revascularization |
2.8% |
3.5% |
0.20 |
These results were maintained across multiple subgroups defined by time of randomization, age, sex, presence of ACS, presence of diabetes, ejection fraction, lesion type, and type of DES.
Over a full 4 years of follow-up, the only endpoint that differed was TIMI major bleeding, which was reduced with aspirin monotherapy (2.5% vs. 3.9%; HR 0.67; 95% CI 0.47-0.95; P = 0.026).
“These findings suggest that 2 antiplatelet strategies provide similar protection from ischemic events with less risk of bleeding in aspirin monotherapy,” Dr. Lee concluded.
Study Details
Baseline characteristics were well matched between groups. The only differences were more multivessel disease (50.5% vs. 47.1%; P = 0.014), more stents per lesion (1.3 ± 0.5 vs. 1.2 ± 0.5; P = 0.013), and longer stent length per lesion (30.8 ± 16.3 mm vs. 29.9 ± 15.4 mm; P = 0.028) in the dual therapy group.
Source:
Lee CW. Optimal duration of clopidogrel therapy with DES to reduce late coronary arterial thrombotic event. The DES LATE trial. Presented at: American College of Cardiology Scientific Session; March 10, 2013; San Francisco, CA.
Disclosures:
- Dr. Lee reports no relevant conflicts of interest.
Related Stories:
Jason R. Kahn, the former News Editor of TCTMD, worked at CRF for 11 years until his death in 2014…
Read Full Bio
Comments