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January 10, 2007

Does Clopidogrel Each Day Keep Stent Thrombosis Away?

Author Affiliations

Author Affiliations: The Heart Center of Greater Cincinnati and The Lindner Research Center at The Christ Hospital, Cincinnati, Ohio; and The Ohio State University, Columbus.

JAMA. 2007;297(2):209-211. doi:10.1001/jama.297.2.209

New medicines and new methods of cure always work miracles . . . for a while.
William Heberden, MD

The polymer-based elution of antiproliferative medications from a metal stent prosthesis has been demonstrated to suppress neointimal proliferative response to stent-vessel injury and to reduce consequent late arterial lumen loss and restenosis. In randomized controlled trials, drug-eluting stents compared with bare-metal stents caused a 70% to 80% reduction in binary (>50%) angiographic restenosis and a 50% to 70% reduction in repeat target lesion or vessel revascularization.1,2 Furthermore, comprehensive follow-up to 1 year demonstrated no evidence for any excess in the incidence of death, myocardial infarction (MI), or stent thrombosis for either treatment strategy.3,4 Thus, based on pivotal clinical trial evidence for both the relative safety and efficacy of drug-eluting stents, the US Food and Drug Administration approved both Cypher, the sirolimus-eluting stent, in 2002, as well as TAXUS, the paclitaxel-eluting stent device, in 2004. Subsequently, multiple other drug-eluting stent platforms have become available outside of the United States.

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