Safety and Efficacy of Ticlopidine After Stent Placement

To the Editor: We have read with interest the article by Dr Berger and colleagues regarding safety and efficacy of ticlopidine for only 2 weeks after successful intracoronary stent placement.1 The authors conclude that “in patients receiving intracoronary stents, the discontinuation of ticlopidine therapy 14 days after stent placement is associated with a very low frequency of stent thrombosis and other adverse events.” In our opinion, 3 major points need to be discussed regarding this conclusion. First, the authors point out that intravascular ultrasound study (IVUS) was used “to facilitate stent placement in 73 patients (8.8%).” IVUS led to additional treatment (additional balloon inflation or placement of additional stents) in 36 patients. This point is crucial and needs to be discussed. Colombo and coworkers2 first demonstrated that optimization of stent implantation was a key issue in the prevention of subacute occlusion. Albiero et al3 demonstrated that stent thrombosis and other adverse events were not significantly different between the aspirin …