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To the Editor: In studying the appropriate duration of dual antiplatelet therapy in patients with DES, Dr Eisenstein and colleagues¹ report the results obtained from the analysis of a large registry of patients who underwent intracoronary stents. They found that in patients with DES, extended use of clopidogrel with aspirin appears to be associated with a reduction in rates of death, as well as the composite outcome of death or myocardial infarction. While these results provide value while waiting for an eventual randomized clinical trial, they would be more interpretable with additional information.

As is the case for all observational research, this study is vulnerable to selection bias. Patients who received a DES and were still taking clopidogrel at 12 months (and even later) may have had healthier lifestyles (healthy user bias) and might have adhered to a greater extent to therapies known to reduce long-term clinical outcomes, such as . . . [Full Text of this Article]

Alexis Matteau, MD
almatteau@videotron.ca

Jacques LeLorier, MD, PhD, FRCPC
Centre Hospitalier de l’Université de Montréal
Montréal, Québec

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