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An observational study done in Veterans Affairs hospitals points to a possible “rebound effect” associated with abrupt clopidogrel discontinuation. The researchers noted a clustering of adverse effects, namely death and myocardial infarction (heart attack), around 90 days after discontinuing clopidogrel. The observation was true for both those treated medically and those who underwent angioplasty with stenting.

Senior author Dr. John Rumsfeld (Denver VA Medical Center) told heartwire: “This is a red flag, suggesting an increased risk of events on stopping clopidogrel. There have been many anecdotal reports of this phenomenon, but this is the first study conducted specifically to look for it.” Rumsfeld said there were two possibilities as to how to deal with it: keep the patient on clopidogrel for longer periods or taper the dose when stopping. “We need to study each of these possibilities to find out which one is best. But until we know for sure, physicians should discuss with each patient how they want to handle the situation after they have taken clopidogrel for a year after an ACS event. A patient who is doing well on clopidogrel, has no bleeding issues or other side effects, and can afford it may want to stay on the drug long term. If they want to come off the dug, then tapering the dose over a few weeks may be a good idea. Or perhaps the dose of aspirin could be doubled for a while. I can’t recommend any of these things as we haven’t got the data; they are just suggestions,” he said.

Until further investigations elucidate the problem, I think we should practice tapering rather than abrupt discontinuation.

[via Medscape]

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