One year later, diabetic patients who were treated with a drug-eluting stent were less likely to have suffered a heart attack or died if they continued taking clopidogrel than if they discontinued the medication (2.2 percent versus 5.5 percent, respectively; p=0.07). More surprising was the finding that even with bare metal stents, long-term clopidogrel therapy significantly reduced the risk of death or heart attack (3.5 percent versus 12.2 percent, p=0.01). Among patients who discontinued clopidogrel after 6 months, the difference in the combined rate of death or heart attack for drug-eluting and bare metal stents was not statistically significant.
Dr. Brar speculated that in diabetic patients, long-term clopidogrel therapy may be helpful regardless of the type of stent because it prevents blood clots from forming on inflamed plaques throughout the diseased coronary arteries, not just on the stent itself.
As for when it is safe to stop clopidogrel in diabetic patients, the study recorded the lowest rate of death or heart attack among those who continued therapy for up to 1 year. After that, the anti-clotting medication did not further reduce risk.
"Regardless of the type of stent, clopidogrel should be continued for more than 6 monthsand perhaps for as long as 1 yearin diabetic patients, whenever possible," Dr. Brar said.
Contact: Kathy Boyd David
Society for Cardiovascular Angiography and Interventions