Stopping or continuing clopidogrel 12 months after drug-eluting stent placement: The OPTIDUAL randomized trial

Gerard Helft, Philippe Gabriel Steg, Claude Le Feuvre, Jean Louis Georges, Didier Carrie, Xavier Dreyfus, Alain Furber, Florence Leclercq, Helene Eltchaninoff, Jean François Falquier, Patrick Henry, Simon Cattan, Laurent Sebagh, Pierre Louis Michel, Albert Tuambilangana, Nadjib Hammoudi, Franck Boccara, Guillaume Cayla, Herve Douard, Abdourahmane DialloEmmanuel Berman, Michel Komajda, Jean Philippe Metzger, Eric Vicaut

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151 Scopus citations

Abstract

This open-label, randomized, and multicentre trial tested the hypothesis that, on a background of aspirin, continuing clopidogrel would be superior to stopping clopidogrel at 12 months following drug-eluting stent (DES) implantation. Methods and results Patients (N = 1799) who had undergone placement of ≥1 DES for stable coronary artery disease or acute coronary syndrome were included in 58 French sites (January 2009-January 2013). Patients (N = 1385) free of major cardiovascular/cerebrovascular events or major bleeding and on aspirin and clopidogrel 12 months after stenting were eligible for randomization (1:1) between continuing clopidogrel 75 mg daily (extended-dual antiplatelet therapy, DAPT, group) or discontinuing clopidogrel (aspirin group). The primary outcome was net adverse clinical events defined as the composite of death, myocardial infarction, stroke, or major bleeding. Follow-up was planned from a minimum of 6 to a maximum of 36 months after randomization. Owing to slow recruitment, the study was stopped after enrolment of 1385 of a planned 1966 patients. Median follow-up after stenting was 33.4 months. The primary outcome occurred in 40 patients (5.8%) in the extended-DAPT group and 52 in the aspirin group (7.5%; hazard ratio 0.75, 95% confidence interval 0.50-1.28; P = 0.17). Rates of death were 2.3% in the extended-DAPT group and 3.5% in the aspirin group (HR 0.65, 95% CI 0.34-1.22; P = 0.18). Rates of major bleeding were identical (2.0%, P = 0.95). Conclusions Extended DAPT did not achieve superiority in reducing net adverse clinical events compared to 12 months of DAPT after DES placement. The power of the OPTIDUAL trial was however low and reduced by premature termination of enrolment.

Original languageEnglish
Pages (from-to)365-374
Number of pages10
JournalEuropean Heart Journal
Volume37
Issue number4
DOIs
StatePublished - 21 Jan 2016
Externally publishedYes

Keywords

  • Bleeding
  • Clopidogrel
  • Drug-eluting stent
  • Dual antiplatelet therapy
  • Myocardial infarction
  • Randomized trial

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