From the Guidelines
Patients should take Plavix (clopidogrel) for at least 12 months after a coronary artery stent placement, as recommended by the 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease 1. The duration of Plavix therapy may vary depending on the type of stent and individual risk factors.
- For bare metal stents, the recommended duration is usually at least 1 month,
- while drug-eluting stents require longer therapy, typically 6 to 12 months. In high-risk patients or those with acute coronary syndrome, treatment may be extended to 12 months or longer. Plavix is generally taken at a dose of 75 mg once daily, often alongside low-dose aspirin (81 mg daily) as dual antiplatelet therapy. This medication prevents platelets from sticking together and forming clots inside the stent, which could cause a heart attack. It's crucial not to stop taking Plavix without consulting your cardiologist, as premature discontinuation significantly increases the risk of stent thrombosis. Side effects may include increased bleeding risk, bruising, and rarely, severe bleeding complications. Regular follow-up with your cardiologist is essential to monitor therapy and determine the appropriate duration for your specific situation, as the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention also recommends 1. The most recent guidelines from 2016 should be followed, as they provide the most up-to-date recommendations based on the latest evidence 1.
From the Research
Duration of Plavix Use after Stent Placement
The duration of Plavix (clopidogrel) use after stent placement in the coronary artery is a critical aspect of patient care. According to the available evidence:
- The Dual Antiplatelet Therapy (DAPT) Study 2 compared the benefits and risks of 12 versus 30 months of dual antiplatelet therapy in preventing stent thrombosis or major adverse cardiovascular and cerebrovascular events.
- Current clinical practice guidelines recommend at least 6- to 12 months of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor such as clopidogrel 3.
- A prospective, observational cohort study found that early discontinuation of clopidogrel (within the first 6 months after DES placement) was a major predictor of stent thrombosis 4.
- The combination of clopidogrel (loading dose, 300-600 mg; maintenance dose, 75 mg/d) and low-dose aspirin (75-162 mg/d) for 12 months is the preferred regimen for the prevention of stent thrombosis and cardiac complications after DES placement 4.
Key Considerations
Some key considerations for the duration of Plavix use after stent placement include:
- The type of stent implanted, with drug-eluting stents (DES) requiring longer durations of dual antiplatelet therapy compared to bare-metal stents (BMS) 2, 5.
- The individual patient's risk profile, with those at high risk for major bleeding during surgery potentially requiring interruption of antiplatelet therapy, while those at high risk of stent thrombosis should continue dual antiplatelet therapy throughout surgery 5.
- The potential benefits and risks of extended dual antiplatelet therapy, including the reduction of stent thrombosis and major adverse cardiovascular events, but also the increased risk of bleeding 2, 4.