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Arik Wolak, Doron Zahger, Management and prevention of thrombotic stent occlusion, European Heart Journal, Volume 26, Issue 21, November 2005, Page 2345, https://doi.org/10.1093/eurheartj/ehi545
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We read with a great interest, the paper by Wenaweser et al.1 who report the efficacy and outcome of emergency percutaneous coronary interventions in patients with stent thrombosis.
Recently, we published our data on 1519 consecutive patients who underwent 2020 stent implantations and were discharged on dual anti-platelet therapy. We compared the short- and long-term risks of thrombotic stent occlusion (TSO) and mortality in patients given clopidogrel or ticlopidine.2,3
The rates of TSO during the first year of follow-up, in our study, were 1.8, 0.7, and 2.8% in the whole group, the ticlopidine group and the clopidogrel group (P<0.01). A multivariate model showed that clopidogrel (vs. ticlopidine) treatment was the sole predictor of TSO (OR=5.4, 95% CI=1.2–24.1, P=0.028). Of even greater concern, clopidogrel treatment was associated with an increased risk of 1-year mortality (OR=1.8, 95% CI=1.2–2.8). Our data are in agreement with those published by Mueller et al.4 who reported that the extended follow-up data of their initial randomized trial which compared clopidogrel with ticlopidine after stenting. Similar to our findings, these investigators reported a significantly higher rate of mortality, both overall and cardiovascular, in the clopidogrel arm.
