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Question
Posted by: Annie | 2012-09-06

Dual anti platelet therapy

I am on clopidogrel and 81mg ecotrin daily for 8 and half months now, after having a drug eluting stent (Xience V) placed in a cardiac artery due to 70% blockage (Mild heart attack.
Cardiologist told me I can go off the clopidogrel now, as the most recent information revealed that 6 months dual anti platelet therapy is sufficient for drug eluting stents,as opposed to a minimum of 12 months as was generally prescribed to patients?

Can I stop the clopidogrel now, would it be a good idea? I am rather apprehensive to do so, but then again, I am not a cardiologist.

Many thanks

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Our expert says:
Expert ImageCardiologist

Dear Annie, thanks for your query.

The combination of clopidogrel and Ecotrin is standard treatment after a drug eluting stent such as a Xience V, and your cardiologist is quite correct, Some experts now believe that it may not be necessary to take dual anti-platelet therapy for quite as long as was initially recommended.

The reason to take dual anti-platelet therapy in the first place is to minimize the risk of late stent thrombosis, ie clotting within the stent. Most of that risk has disappeared by eight months. However, the risk does not disappear completely, and there is little to be lost by taking DAPT for a full year, especially if the artery is a very large and important one, or if you are anxious.

My practice is still to recommend DAPT for a full year, unless there are good reasons for stopping clopidogrel earlier. However, other cardiologists may have different opinions and there is no completely right or wrong answer. If you are anxious about stopping early, and have no side effects, then it is not unreasonable to take the drug for the full twelve months.

Best wishes, JT.

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Our users say:
Posted by: Mark | 2012-09-20

I learned a lot from your story and this seervs as a wake up call for me also. I know this has been a big event in your life and thank you so much for sharing this not just to me but to many people who might get inspired and be more conscious of themselves.

Reply to Mark
Posted by: Cardiologist | 2012-09-07

Dear Annie, thanks for your query.

The combination of clopidogrel and Ecotrin is standard treatment after a drug eluting stent such as a Xience V, and your cardiologist is quite correct, Some experts now believe that it may not be necessary to take dual anti-platelet therapy for quite as long as was initially recommended.

The reason to take dual anti-platelet therapy in the first place is to minimize the risk of late stent thrombosis, ie clotting within the stent. Most of that risk has disappeared by eight months. However, the risk does not disappear completely, and there is little to be lost by taking DAPT for a full year, especially if the artery is a very large and important one, or if you are anxious.

My practice is still to recommend DAPT for a full year, unless there are good reasons for stopping clopidogrel earlier. However, other cardiologists may have different opinions and there is no completely right or wrong answer. If you are anxious about stopping early, and have no side effects, then it is not unreasonable to take the drug for the full twelve months.

Best wishes, JT.

Reply to Cardiologist

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