Background: There is mounting evidence that delayed endothelialization after drug-eluting stent (DES) implantation may lead to very late stent thrombosis (ST) and related catastrophic events. However, the risk of very late ST following cessation of clopidogrel in patients with DES in real-world practice remains less defined.Methods: A total of 1031 consecutive patients (male 66.6 %, mean age 62.2 짹10.9 years, diabetes 33.5 %) treated with at least 1 DES (Cypher 64 %, Taxus 16 %, Endeavor 13.0 %, combination 7 %) from January 2003 to May 2007, were analyzed in a single academic center. Results: Clopidogrel was discontinued after 1-year of DES implantation in 24.8 %, 256/1031 of patients. The complex lesions (aorto-ostial, multiple stent, chronic total occlusion, and bifurcation using two stents) were more common in clopidogrel stay group than in withdrawal group (p=0.02). We identified 12 patients (1.2 % of the total patients treated with DES) with definite very late ST (male 60 %, mean age 61.7짹10.2 years). The incidence of very late ST was significantly higher in patients who withdrew clopidogrel after 1-year administration compared to those who stayed on clopidogrel (Figure 1). Among the patients with very late ST, the single agent (aspirin 3, cilostazol 3, sarpogrelate 1) were used in 7 patients (7/12, 58.3 %) (Figure 2).Conclusion: Long-term use of dual anti-platelet regimen of aspirin and clopidogrel beyond 1-year in patients with DES could be associated with a reduced risk for very late ST in real-world practice.