Coronary artery stenting in patients treated by clopidogrel without aspirin

Background: Combined therapy with aspirin and clopidogrel is currently the standard treatment for patients undergoing coronary artery stenting. Some stented patients do not tolerate aspirin and are treated by clopidogrel only, the risk of major adverse clinical events (MACE) in such patients is unclear. Objective: To assess the risk of MACE in stented patients treated by clopidogrel only. Methods: We reviewed records of consecutive patients who underwent bare metal coronary stenting between 1999 and 2004, looking for patients that were treated by clopidogrel without aspirin. Our search revealed 43 such patients with adequate clinical follow-up for at least 1 year following the procedure. We collected information regarding stent thrombosis, acute MI, death or repeat PCI. Results: Two patients (4.7%) were admitted due to acute MI within 30 days of stenting. Stent thrombosis was documented by coronary angiography and target vessel revascularization was performed. Conclusions: Clopidogrel as a sole anti-platelet treatment after coronary stenting resulted in a relatively high percentage of subacute stent thrombosis. Even higher percentages may be expected when using drug eluting stents. More aggressive anti-platelet therapy may be needed in patients who cannot tolerate aspirin. PTCA alone may be preferable to stenting in such patients.