In Reply: Dr Kim raises the hypothesis that the clustering of adverse events following stopping clopidogrel is attenuated with longer clopidogrel treatment, specifically among patients taking clopidogrel for longer than 9 months following discharge after acute coronary syndrome. Although length of therapy was not the focus of our investigation, we did include subgroup analysis based on treatment length. Among patients taking clopidogrel for longer than 9 months, 69.6% of total events occurred in the 0- to 90-day interval after stopping clopidogrel, which is higher than the 60.8% reported for the overall medically treated cohort. For the subgroup treated longer than 9 months, the 95% confidence interval (CI) (0.96-3.34) crossed 1, but the interval was wide due to a smaller sample size of patients taking longer courses of clopidogrel, and the magnitude of effect (adjusted incidence rate ratio, 1.79) was similar to the overall cohort, supporting the primary conclusion.
Ho PM, Rumsfeld JS. Adverse Events Associated With Stopping Clopidogrel After Acute Coronary Syndrome—Reply. JAMA. 2008;299(20):2388-2390. doi:10.1001/jama.299.20.jlt0528-h