Patient compliance is key

The four year follow up of the study known as TYCOON or Two-Year Clopidogrel Need registry was published online September 28, 2009 in the American Journal of Cardiology. This study was not randomized; it was a registry study, meaning that consecutive patients were enrolled and then compared to another group. 897 consecutive patients who underwent stenting in 2003 and 2004 were enrolled and three groups were created. 450 patients had bare metal stents and took dual antiplatelet therapy or DAPT for one month and then aspirin. 173 patients who had drug eluting stents took DAPT for 12 months and then aspirin. 274 patients who had drug eluting stents took DAPT for 24 months and then aspirin.

During follow up, the bare metal group had 3 stent thrombosis events one acute, one subacute (<30 days) and one late (30 days -1 yr). The 1 yr group had 1 subacute and 4 very late (>1 yr). The 24 month group had 1 subacute and no other thrombosis events.

This was not randomized study and not powered to provide true statistical answers. It is however compelling data. The DAPT study will have over 20,000 patients and is powered to show any difference in rates of stent thrombosis and major cardio and cerebrovascular events. The primary safety endpoint is major bleeding.

TYCOON does however once again point out how important patient compliance with this medicine is. If you have a stent it is imperative not to stop either aspirin or Plavix until your cardiologist says so, no matter what other doctors or people may tell you. Cleaning your teeth is important but not a reason to die. Before any cardiac procedure it is important to tell your doctors any future surgery that maybe needed or planned so that proper choices can be made.

Stenting coronary arteries can be a significant benefit to patients. It is however one area of medicine that requires significant input and cooperation. As new stents and drugs are developed all this will change, for now this is all we know.

This entry was posted on Sunday, November 1st, 2009 at 6:47 am and is filed under Cholesterol. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.