Home > Interventional Cardiology, Journal Club > Journal Club 17 June 2015

Journal Club 17 June 2015

Paper

Duration of Triple Therapy in Patients Requiring Oral Anticoagulation After Drug-Eluting Stent Implantation The ISAR-TRIPLE Trial

Presenter

KC

Summary

BACKGROUND

Patients receiving oral anticoagulation (OAC) who undergo drug-eluting stent (DES) implantation
require additional dual antiplatelet therapy with aspirin and clopidogrel. Such triple therapy confers an elevated bleeding
risk, and its optimal duration is not known.

OBJECTIVES

The goal of this study was to evaluate whether shortening the duration of clopidogrel therapy from
6 months to 6 weeks after DES implantation was associated with a superior net clinical outcome in patients receiving
concomitant aspirin and OAC.

METHODS

In this randomized, open-label trial, we enrolled patients receiving OAC who underwent DES implantation at
3 European centers between September 2008 and December 2013. A total of 614 patients receiving concomitant aspirin
and OAC were randomized to either 6-week clopidogrel therapy (n ¼ 307) or 6-month clopidogrel therapy (n ¼ 307). The
primary endpoint was a composite of death, myocardial infarction (MI), definite stent thrombosis, stroke, or Thrombolysis
In Myocardial Infarction (TIMI) major bleeding at 9 months.

RESULTS

The primary endpoint occurred in 30 patients (9.8%) in the 6-week group compared with 27 patients (8.8%)
in the 6-month group (hazard ratio [HR]: 1.14; 95% CI: 0.68 to 1.91; p ¼ 0.63). There were no significant differences
for the secondary combined ischemic endpoint of cardiac death, MI, definite stent thrombosis, and ischemic stroke
(12 [4.0%] vs. 13 [4.3%]; HR: 0.93; 95% CI: 0.43 to 2.05; p ¼ 0.87) or the secondary bleeding endpoint of TIMI major
bleeding (16 [5.3%] vs. 12 [4.0%]; HR: 1.35; 95% CI: 0.64 to 2.84; p ¼ 0.44).

CONCLUSIONS

Six weeks of triple therapy was not superior to 6 months with respect to net clinical outcomes. These
results suggest that physicians should weigh the trade-off between ischemic and bleeding risk when choosing the shorter
or longer duration of triple therapy.

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