Clinical research studyLate Thrombosis of Drug-Eluting Stents: A Meta-Analysis of Randomized Clinical Trials
Section snippets
Literature Review
We searched the MEDLINE and Cochrane databases for randomized clinical trials in English language from 2000 to 2005 using the Medical Subject Heading terms “Angioplasty, Transluminal, Percutaneous Coronary”, “Stents”, “Paclitaxel”, “Sirolimus” and “Thrombosis.” We also hand-searched relevant journals, obtained recently presented data at cardiology conferences (scientificsessions.americanheart.org, www.acc.org, and www.tctmd.com), corresponded with authors and experts in the field, and used the
Duration of Dual AntiPlatelet Therapy and Duration of Clinical Follow-Up
In all, there were 14 studies with 6675 total patients included for analysis. There were 9 sirolimus trials, largely represented by the SIRIUS and RAVEL Trials (Table 1),9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 and 5 paclitaxel trials represented by the TAXUS Trials (Table 2).23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 Most of the sirolimus trials mandated aspirin and clopidogrel for 2 to 3 months, except for the Pache et al Trial21 and the DIABETES Trial,20 which required 6 and 12
Discussion
In this analysis of 14 studies in over 6000 patients, the incidence of early thrombosis was similar between drug-eluting stents and bare metal stents. Increased risk with drug-eluting stents was suggested as early as 1 month after revascularization; however, more than 6 to 12 months after the procedure there was a 4- to 5-fold excess of drug-eluting stent thrombosis compared with bare metal stents. The time until late thrombosis was equally protracted for both sirolimus and paclitaxel stents,
References (38)
- et al.
What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention?A meta-analysis
J Am Coll Cardiol
(2005) - et al.
Risk of thrombosis with the use of sirolimus-eluting stents for percutaneous coronary intervention (from registry and clinical trial data)
Am J Cardiol
(2005) - et al.
A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents
Lancet
(2004) - et al.
Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies
J Am Coll Cardiol
(2005) - et al.
Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation
J Am Coll Cardiol
(2005) - et al.
Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy
Lancet
(2004) - et al.
Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomised controlled trial (E-SIRIUS)
Lancet
(2003) - et al.
The Canadian study of the sirolimus-eluting stent in the treatment of patients with long de novo lesions in small native coronary arteries (C-SIRIUS)
J Am Coll Cardiol
(2004) - et al.
Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting
J Am Coll Cardiol
(2002) - et al.
Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis
J Am Coll Cardiol
(2005)