Cardiology>>>>>Ischaemic heart disease
Question 119#

A 66-year-old woman had a second-generation DES implantation after an acute MI. What is the correct statement?

A. To prevent DES late thrombosis, dual antiplatelet therapy with aspirin and clopidogrel is recommended for 3 years
B. Based on the results of the CHARISMA (Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization Management, and Avoidance) trial, aspirin and clopidogrel should be administered for at least 2 years in patients with an acute coronary event, independently of the implantation of a DES
C. At 1 year, clopidogrel may be discontinued but if the patient is on lowdose aspirin, the dose of aspirin has to be increased to 325 mg/day
D. In patients who have already suffered a stent thrombosis dual antiplatelet therapy may be extended long term, although currently there are no data to support this strategy
E. Following DES implantation, aspirin should be discontinued at 12 months and clopidogrel administered indefinitely

Correct Answer is D

Comment:

In patients who have already suffered a stent thrombosis dual antiplatelet therapy may be extended long term, although currently there are no data to support this strategy. Currently, there are no data to support an extension of dual antiplatelet therapy beyond 12 months. Nevertheless, in selected patients at high risk for stent thrombosis, aspirin and clopidogrel may be administered for a longer period of time. The CHARISMA trial did show a benefit of prolonged aspirin and clopidogrel therapy over aspirin only in the secondary prevention setting, but did not specifically address the PCI population. According to the 2011 AHA/ACC PCI, continuation of P2Y12 inhibitor after stent implantation for ACS should be at least 12 months.