From the Guidelines
The recommended duration of therapy with Plavix (clopidogrel) is at least 12 months after drug-eluting stent (DES) implantation for acute coronary syndrome (ACS) patients, and 1-6 months for stable coronary artery disease (CAD) patients treated with percutaneous coronary intervention (PCI), depending on the bleeding risk [ 1 ].
Key Considerations
- Bleeding risk assessment: The duration of dual antiplatelet therapy (DAPT) should be individualized based on the patient's ischemic and bleeding risk [ 1 ].
- Stent type: The type of stent implanted (e.g., bare metal stent, DES) does not dictate the duration of DAPT [ 1 ].
- High bleeding risk patients: For patients at high risk of bleeding, a shorter duration of DAPT (e.g., 6 months) may be considered [ 1 ].
- Prolonged DAPT: Prolonged DAPT beyond 12 months may be considered in patients who have tolerated DAPT without a bleeding complication and are not at high bleeding risk [ 1 ].
Clinical Context
In clinical practice, the decision to extend or shorten the duration of DAPT should be based on a careful assessment of the patient's individual risk factors, including their ischemic and bleeding risk [ 1 ].
Medication Options
Clopidogrel is considered a default P2Y12 inhibitor in patients with stable CAD treated with PCI, those with an indication for concomitant oral anticoagulation, and in ACS patients in whom ticagrelor or prasugrel are contraindicated [ 1 ].
Guideline Recommendations
The American College of Cardiology (ACC) and American Heart Association (AHA) recommend at least 12 months of DAPT after DES implantation for ACS patients [ 1 ], while the European Society of Cardiology (ESC) recommends a default duration of 12 months for ACS patients undergoing PCI [ 1 ].
From the FDA Drug Label
The CURE study included 12,562 patients with ACS without ST-elevation (UA or NSTEMI) and presenting within 24 hours of onset of the most recent episode of chest pain or symptoms consistent with ischemia. Patients were randomized to receive clopidogrel (300 mg loading dose followed by 75 mg once daily) or placebo, and were treated for up to one year.
The recommended duration of therapy with Plavix (clopidogrel) is up to one year in patients with Acute Coronary Syndrome (ACS) without ST-elevation, as demonstrated in the CURE study 2.
From the Research
Recommended Duration of Therapy with Plavix (Clopidogrel)
The recommended duration of therapy with Plavix (clopidogrel) varies depending on the type of stent implanted and the patient's condition.
- For patients with bare-metal stents, the recommended duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is at least 1 month 3, 4.
- For patients with drug-eluting stents, the recommended duration of DAPT is at least 12 months 3, 5, 4, 6.
- Some studies suggest that a longer duration of therapy, such as 12-18 months or even indefinitely, may be beneficial in preventing very late stent thrombosis 7.
- The American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines recommend DAPT for 12 months after drug-eluting stent placement 4, 6.
Factors Influencing Duration of Therapy
The duration of therapy with clopidogrel may be influenced by several factors, including:
- Type of stent implanted: bare-metal stents require a shorter duration of DAPT compared to drug-eluting stents 3, 4.
- Patient's condition: patients with acute coronary syndrome or those who have undergone percutaneous coronary intervention may require a longer duration of DAPT 6.
- Risk of bleeding: patients at high risk of bleeding may require a shorter duration of DAPT or a modified regimen 5, 6.