Recommendation ID
CG172/5
Question
In people who have had a STEMI who undergo primary PCI with a bare-metal stent, and 4 weeks of aspirin and clopidogrel, is there an additional benefit to continuing clopidogrel for a further 11 months?
Any explanatory notes
(if applicable)
Why this is important:- There are no randomised controlled trials that provide data on long-term treatment with clopidogrel plus aspirin compared with aspirin alone in patients who are treated with primary PCI or medical therapy alone. Two large trials have provided data on short-term efficacy in medically treated STEMI patients (Commit/CCS-2 and Clarity – TIMI 28). In clinical practice, doctors extrapolate the data from patients with NSTEMI, in whom this problem has been studied in both medically and invasively managed patients, who receive clopidogrel for up to 12 months (CURE, PCI-CURE, CREDO) because of a reduction in composite endpoints including mortality. The risk of bleeding increases with dual antiplatelet therapy (aspirin with clopidogrel), but the majority of benefit might occur in the short-term reduction of fatal and non-fatal re-infarction, and a reduced risk of stent thrombosis in patients treated with PCI.

Source guidance details

Comes from guidance
Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease
Number
CG172
Date issued
November 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 19/12/2013