To the Editor: In their study of thrombosis after implantation of drug-eluting stents, Dr Iakovou and colleagues1 concluded that premature discontinuation of antiplatelet therapy was the strongest predictor of subacute or late thrombotic occlusion of drug-eluting stents. This is a major issue, given the increasing rate of drug-eluting stent implantation with a prolonged indication for dual-antiplatelet therapy. The study does not provide reasons 17 patients stopped using the oral antiplatelet agent. This information is important for a number of reasons.
First, interruption of antiplatelet therapy is associated with recurrent acute coronary syndromes (ACS) in otherwise stable patients. Interruption of antiplatelet therapy has been identified in 4.1% to 5.4% of all patients admitted for ACS2 - 3 and can lead to a catastrophic short-term outcome.2
Second, incomplete adherence and intolerance due to minor bleeding account for 20% to 30% of interruption of antiplatelet therapy.2 - 3 This interruption may be initiated by physicians to minimize bleeding that may occur during planned procedures including dental work, surgery, and endoscopy. In these situations, it is assumed that the bleeding risk overwhelms the risk of ACS recurrence. However, there is evidence that interruption of antiplatelet therapy is not justified in most of these cases either because of the low bleeding risk of the planned procedure or because there is an overriding benefit of maintaining the therapy, as in peripheral vascular surgery.2 - 4 In addition, postoperative platelet hyperactivation and hypercoagulability on top of the progressive recovery of platelet function following interruption of therapy may trigger stent thrombosis.5
Therefore, it would be of interest to know the reasons for premature interruption of antiplatelet therapy in these 17 patients and to examine the timing between interruption and the acute coronary event. This information would help determine whether these thromboses of drug-eluting stents could have been avoided.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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