Is a Stent Your Best Option?

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Studies Find Worrisome Risks

In 2006 several reports of heart attacks and deaths occurring in patients with drug-eluting stents who had stopped using Plavix as much as one year after their stent procedure raised new concerns about the optimal duration of blood thinner use .

One of the first was a Swiss study, presented at the annual American College of Cardiology meeting in March 2006. It looked at what happens after stopping Plavix six months after stent implantation.

The results: Compared with bare metal stents, the use of drug-eluting stents:
- Reduced the risk of needing another cardiac procedure by half.
- Resulted in a two- to threefold increase in death or heart attack, often due to abrupt clotting.

Other studies showed similar findings.

The Food and Drug Administration met in December 2006 to review the research. Published data suggest the clotting risk is small—occurring in fewer than one in every 500 patients, but with so many stents being placed each year, it can affect a large number of people.

The new recommendation: An advisory was issued to physicians recommending that patients who get drug-coated stents continue antiplatelet therapy—with aspirin, Plavix, and other drugs—for at least a year after the procedure and, pending ongoing research, possibly indefinitely.

There is, however, a downside to long-term use of these drugs. Aspirin and Plavix:

• Can cause patients to bruise easily.

• Can increase the risk of serious bleeding.

• Lead to a serious bleeding episode in an estimated one in 50 patients who take the aspirin/Plavix combination.

• Can be expensive (around $120 per month), and stopping the medication prematurely increases the risk of clotting.

Patients must also stop taking Plavix if they require any surgery because it can lead to uncontrolled bleeding.

The bottom line: If you’re likely to need any surgery a year after you get a stent, are at an increased risk of bleeding, or don’t think you’ll be able to take anticlotting medications, a bare metal stent—or another treatment—might be a better choice. Make sure to talk about all these issues with your doctor.