Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Research

Restrictive access to clopidogrel and mortality following coronary stent implantation

Odile Sheehy, Jacques LeLorier and Stéphane Rinfret
CMAJ February 12, 2008 178 (4) 413-420; DOI: https://doi.org/10.1503/cmaj.070586
Odile Sheehy MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jacques LeLorier MD PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stéphane Rinfret MD MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading
Submit a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
References
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Minimum 7 characters.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'. Minimum 12 characters.
Your organization, institution's or residential address.
Statement of Competing Interests

Vertical Tabs

Jump to comment:

  • Increased 12 month mortality post stenting following transient early withdrawal of clopidogrel
    Craig S McLachlan
    Posted on: 26 March 2008
  • Posted on: (26 March 2008)
    Page navigation anchor for Increased 12 month mortality post stenting following transient early withdrawal of clopidogrel
    Increased 12 month mortality post stenting following transient early withdrawal of clopidogrel
    • Craig S McLachlan

    Craig S McLachlan PhD MPH, University of Technology Sydney

    Sheehy and associates (1) examined the association between 12 month mortality outcomes in coronary stented patients and the delay in filling a clopidogrel prescription at the time of hospital discharge. Importantly, if the prescription delay was 1 day this equated to a 34% increase in mortality during a 12 month follow-up period.

    Importantly, t...

    Show More

    Craig S McLachlan PhD MPH, University of Technology Sydney

    Sheehy and associates (1) examined the association between 12 month mortality outcomes in coronary stented patients and the delay in filling a clopidogrel prescription at the time of hospital discharge. Importantly, if the prescription delay was 1 day this equated to a 34% increase in mortality during a 12 month follow-up period.

    Importantly, the study findings by Sheery et al. (1), likely did not encompass stent “late loss” contributing toward overall mortality. For example, identified rates of 18-month cardiac death/MI due to acute thrombosis are not different between patients with bare metal (BMS) or drug eluting (DES) stents. However, after the discontinuation of clopidogrel (between 7 and 18 months), thrombus events have been previously reported to occur in 4.9% after DES versus 1.3% after BMS implantation (2).

    From the Sheehy et al (1) study the following questions emerge; firstly, whether acute thrombosis would have been associated with transient clopidogrel stoppage due to prescription delay? Secondly whether acute thrombosis contributed to the overall 12 month mortality increase observed by Sheehy et al (1)? Indeed, a clustering of adverse events in the initial 90 days after stopping clopidogrel among both medically treated and PCI-treated patients with acute coronary syndromes (ACS) has recently been reported upon, supporting the possibility of a clopidogrel rebound effect. (3).

    Interestingly Sheehy et al. (1) selected patients based on whether they had filled at least 1 prescription for acetylsalicylic acid, warfarin, oral antidiabetic, antihypertensive or lipid-modifying drug. The selection of a diabetic group is relevant because it has been previously demonstrated that in diabetics that clopidogrel withdrawal is associated with acute pro-aggregatory and pro-inflammatory outcomes at 30 days post withdrawal (4).

    In conclusion, whether a 1 day transient stoppage in the use of clopidogrel would be responsible for an acute clopidogrel re-bound effect contributing to mortality across all stent subpopulations remains unanswered. Certainly further clinical investigation on transient interruptions to clopidogrel therapy in ACS are required. The findings of such studies will be important to establish whether the existence of very early and rapid re-bound effects has an adverse effect on ACS clinical outcomes.

    References

    1) Sheehy O, LeLorier J, Rinfret S. Restrictive access to clopidogrel and mortality following coronary stent implantation. CMAJ. 2008 Feb 12;178(4):413-20

    2) M. Pfisterer, H. Brunner-La Rocca, P. Buser, P. Rickenbacher, P. Hunziker, C. Mueller, R. Jeger, F. Bader, S. Osswald, C. Kaiser Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting StentsAn Observational Study of Drug-Eluting Versus Bare- Metal Stents. JACC, Volume 48, Issue 12,2584-2591

    3) Ho PM, Peterson ED, Wang L, Magid DJ, Fihn SD, Larsen GC, Jesse RA, Rumsfeld JS Incidence of death and acute myocardial infarction associated with stopping clopidogrel after acute coronary syndrome. JAMA. 2008 6;299(5):532-9.

    4) Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, Ramírez C, Sabaté M, Jimenez-Quevedo P, Hernández R, Moreno R, Escaned J, Alfonso F, Bañuelos C, Costa MA, Bass TA, Macaya C. Clopidogrel withdrawal is associated with proinflammatory and prothrombotic effects in patients with diabetes and coronary artery disease. Diabetes. 2006 Mar;55(3):780-4.

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 178 (4)
CMAJ
Vol. 178, Issue 4
12 Feb 2008
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Restrictive access to clopidogrel and mortality following coronary stent implantation
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Restrictive access to clopidogrel and mortality following coronary stent implantation
Odile Sheehy, Jacques LeLorier, Stéphane Rinfret
CMAJ Feb 2008, 178 (4) 413-420; DOI: 10.1503/cmaj.070586

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Restrictive access to clopidogrel and mortality following coronary stent implantation
Odile Sheehy, Jacques LeLorier, Stéphane Rinfret
CMAJ Feb 2008, 178 (4) 413-420; DOI: 10.1503/cmaj.070586
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Interpretation
    • Footnotes
    • REFERENCES
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Highlights of this issue
  • Dans ce numéro
  • Mortality benefit from unrestricted access to clopidogrel: Too good to be true?
  • PubMed
  • Google Scholar

Cited By...

  • Prior Authorization: Problems and Solutions
  • Delay in Filling First Clopidogrel Prescription After Coronary Stenting Is Associated With an Increased Risk of Death and Myocardial Infarction
  • Telephone contact to improve adherence to dual antiplatelet therapy after drug-eluting stent implantation
  • The potential economic impact of restricted access to angiotensin-receptor blockers
  • Predictors of Early Discontinuation of Dual-Antiplatelet Therapy: Room for Improvement
  • Delays in Filling Clopidogrel Prescription After Hospital Discharge and Adverse Outcomes After Drug-Eluting Stent Implantation: Implications for Transitions of Care
  • Problem of immortal time bias in cohort studies: example using statins for preventing progression of diabetes
  • Impact of Restrictive Prescription Plans on Heart Failure Medication Use
  • A population-based study of the drug interaction between proton pump inhibitors and clopidogrel
  • Mortality benefit from unrestricted access to clopidogrel: Too good to be true?
  • Google Scholar

More in this TOC Section

  • The risk of death or unplanned readmission after discharge from a COVID-19 hospitalization in Alberta and Ontario
  • The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis
  • Projected estimates of cancer in Canada in 2022
Show more Research

Similar Articles

Collections

  • Topics
    • Drug regulation
    • Drugs: cardiovascular system
    • Health policy

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire