What is the recommended duration of therapy with Clopidogrel (Plavix) after coronary stent placement?

From the Guidelines

The recommended duration for Plavix (clopidogrel) after coronary stent placement is at least 12 months for patients receiving a stent during PCI for acute coronary syndrome, and at least 12 months for patients receiving drug-eluting stents for non-acute coronary syndrome indications, if patients are not at high risk of bleeding, as supported 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 used, with bare metal stents typically requiring at least 1 month of therapy, and drug-eluting stents requiring at least 6-12 months of therapy. Some newer-generation drug-eluting stents may allow for shorter durations of 3-6 months in certain patients. Key considerations for determining the duration of Plavix therapy include:

• The type of stent used (bare metal or drug-eluting)
• The clinical presentation (acute coronary syndrome or non-acute coronary syndrome)
• The patient's bleeding risk
• The complexity of the stent procedure Plavix is usually prescribed alongside aspirin (75-100 mg daily) as part of dual antiplatelet therapy (DAPT) to prevent platelets from sticking together to form clots, which is crucial during the period when the stent is becoming incorporated into the vessel wall. Stopping Plavix earlier than recommended significantly increases the risk of stent thrombosis, which can cause a heart attack, as noted in the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention 1. Never discontinue Plavix without consulting your cardiologist, even for minor procedures or surgeries.

From the Research

Duration of Plavix Therapy with Coronary Stents

The optimal duration of Plavix (clopidogrel) therapy in patients with coronary stents is a topic of ongoing debate.

• Studies have shown that the risk of stent thrombosis is higher after discontinuation of clopidogrel, particularly in the first year after stent implantation 2.
• A study published in 2005 suggested that prolonged combination therapy with aspirin and clopidogrel for up to 1 year after percutaneous coronary intervention (PCI) may be beneficial in reducing the risk of stent thrombosis and cardiac complications 2.
• However, a meta-analysis published in 2015 found that longer duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel did not reduce the risk of all-cause mortality, myocardial infarction, cardiac death, stent thrombosis, or cerebrovascular accidents, but was associated with an increased risk of TIMI major bleeding 3.
• Another study published in 2020 discussed the benefits and harms of shorter DAPT regimens after PCI with newer-generation drug-eluting stents (DES) and suggested that current guidelines recommend a duration of DAPT of 6 months for most patients with stable coronary disease and 12 months for most patients with acute coronary syndromes 4.
• A review of efficacy and safety studies published in 2010 found that the combination of clopidogrel and aspirin for 12 months is the preferred regimen for the prevention of stent thrombosis and cardiac complications after DES placement, but that triple antiplatelet therapy may be beneficial in certain high-risk patients 5.
• A study published in 2013 compared dual antiplatelet therapy with prasugrel or ticagrelor versus clopidogrel in interventional cardiology and found that prasugrel or ticagrelor plus aspirin should be the DAPT of choice in patients with acute coronary syndrome (ACS) undergoing PCI unless they are at particularly high risk of bleeding 6.

Key Findings

• The optimal duration of Plavix therapy with coronary stents is still a topic of debate.
• Prolonged combination therapy with aspirin and clopidogrel may be beneficial in reducing the risk of stent thrombosis and cardiac complications.
• Longer duration of DAPT is associated with an increased risk of bleeding complications.
• Current guidelines recommend a duration of DAPT of 6 months for most patients with stable coronary disease and 12 months for most patients with acute coronary syndromes.
• The choice of antiplatelet therapy should be made on an individual patient basis, taking into account the risk of bleeding and other factors.