Stopping medication too soon after receiving a drug-eluting stent raises risk of death

e risk of stent thrombosis lasts for a longer period of time and patients with DES require prolonged thienopyridine therapy (typically for several months).

In a 19-center study of 500 heart attack patients (average age 61 years and 68 percent male) who received a DES and were discharged with prescriptions for thienopyridines, 68 patients (13.6 percent) stopped their medication within 30 days. Those who stopped were:

  • older;
  • less likely to have completed high school;
  • less likely to be married;
  • more likely to avoid health care due to cost;
  • more likely to have pre-existing cardiovascular disease or anemia when they arrived at the hospital; and
  • less likely to have received discharge instructions about their medications or be referred for cardiac rehabilitation.

After one year, 7.5 percent of patients who stopped their medication within the first 30 days had died compared to 0.7 percent of the compliant patients. In addition, 23 percent of those who stopped their medication early were readmitted to the hospital, compared to 14 percent of those who continued their medication, he said.

"The rate of death was significantly higher and the frequency of cardiac hospitalizations was almost twice as great over the next 11 months among those who stopped their thienopyridines as compared to those who continued them," Spertus said.

Researchers said previous studies under controlled conditions found that the combination of DES plus three to six months of antiplatelet medication effectively prevented restenosis for patients with atherosclerosis.

Yet, clinical trials differ from real-world practice where patients may have less intense follow-up or limited access to the medications they need. That's why it was important to see how patients would fare under real-world conditions, including those getting stents on a more emergency basis, such as for treatment of hear

Contact: Bridgette McNeill
American Heart Association

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