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Drug Eluting vs. Bare Metal Stents

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posted by Tom T., Arizona, USA
Drug-eluting stents apparently have much less long-term restenosis than bare-metal stents, (and that is good ) but in turn, aren't they subject to sudden severe blood-clotting in a few cases, causing massive heart attacks, epecially if one quits taking Plavix, (and that sounds bad ). So doesn't it sound like we're trading a serious stomach ache for many patients for a possible very serious headache for a few patients? Does anyone have any input on this?

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Current Postings on This Page (84):

• hi i am 60yrs old and have 21 stents.this all started when i was 40. so how many can they put in????and have you ever heard of someone having that many???? ty ann
ann, New Port Richie, Florida, USA, May 26, 2011

• Patti -- the Guidelines state 4-6 weeks of Plavix plus aspirin for bare metal stents (minimum) and a year for drug-eluting stents. But every patient is an individual and we would suggest strongly that you discuss the upcoming surgery with your mother's cardiologist BEFORE the stent procedure so he/she is aware of it. Also it wouldn't hurt to get the surgeon in on the conversation. Also look at the topic on Plavix and Surgery.
Angioplasty.Org Staff, Angioplasty.Org, April 18, 2010

• My 84 yo mother is scheduled for an angio with possibly two stents soon. She is scheduled to have a hip replacement in 4 weeks. Is there research on how long she should wait until having the hip replacement? If a bare metal stents are placed, Is 4 weeks of plavix enough and how long should she be off the plavix before surgery? Thank you, Patti L.
Patti L, Hoag Hospital, Newport Beach, CA, USA, April 18, 2010

• I had a bare metal stent placed into my LAD in 1995. It held up well for over 14 years. Recently however my artery restenosed causing a 75% blockage. A Promus stent was placed inside the original stent 3 days ago. I'm now on Plavix and keeping my fingers crossed.
BB, Toms River, New Jersey, USA, September 24, 2009

• Randy -- not sure what specific "risks" you're referring to -- but we certainly don't mean to cause any patient undue anxiety. You are three years out and doing well it seems -- and, according to your post, a beneficiary of this terrific technology where angioplasty is able to treat and stop a heart attack from progressing, saving heart muscle and a lifetime of disability -- something that frankly didn't really exist before the invention of the balloon in 1977. If you're referring to the very recent report, presented at this month's SCAI Annual Meeting, about the over-the-counter acid reflux meds -- the article referenced below was about a new study that showed Proton Pump Inhibitors (Nexium, Prevacid, etc. -- NOT antacids or H2 blockers like Tagamet or Zantac) may also inhibit the effectiveness of Plavix in its anticlotting abilities, at least in some patients. We would assume that three years out this is much less of an issue (are you taking Plavix?) but certainly do what the FDA, AHA, ACC and SCAI recommend and discuss this with your cardiologist (which is what you're doing).
Angioplasty.Org Staff, Angioplasty.Org, May 23, 2009

• Hi. I'm a 54 year old man from Illinois. Sept. 6, 2006 I was taken to a hospital in Texas with an AMI. I had a 99% blockage of my LAD. A Taxus Express2 stent was put in and other than a few touch and go months afterward, I have been doing okay for 32 months. But I also suffer from acid reflux and have been taking any over the counter meds available to me. Now, after finding this site, I am a little anxious! No one has ever mentioned anything about the risks I read here. I go to Illinois Heart and Lung again on June 23rd. I want to ask my cardiologist about this. Thanks for making this information available.
Randy Ayers, Clinton, Illinois, USA, May 22, 2009

• From Nancy - yes, I am going to tell him that this is a site his group should look at because there is a lot of feedback and discussion from patients and up to date news.FWIW, my Father was the recipient of a balloon angioplasty in 1982 in Florida and it held until he died this year at 83 due to complications of lung cancer.
Nancy, South Carolina, USA, May 22, 2009

• Great news Nancy! And thank you for updating us all. We'll bet that your cardiologist would be interested in the fact that you were aware of the nature of his decision-making process. Best of health!
Angioplasty.Org Staff, Angioplasty.Org, May 21, 2009

• From Nancy. Good news for me - I got one of the false positives due to the interference by breast tissue. Coronary arteries were clean; he said there was some plaque - about 10% in some places, but mostly just clear.Of course this is all good to follow and I know where to come to keep up as my husband had a heart attack in 2003 and has two bare metal stents. I felt relieved that before the procedure the cardiologist was talking about diameter and length of any obstruction as part of the decision for which stent to use.
Nancy, South Carolina, USA, May 21, 2009

• Nancy -- recent news (we're just posting this today in fact) is that DES in general have very good long-term outcomes -- better than bare-metal stents. And the safety issues about "ticking time bombs" have been pretty much put to rest -- that is, as long as the patient takes the required antiplatelet medications (aspirin plus Plavix). However, there is still some debate in the interventional cardiology world about when DES are more necessary. In large diameter vessels with relatively short areas of blockage, situations where the risk of restenosis (reblocking) is low, some physicians feel there is virtually no difference between DES and bare-metal. In narrow vessels with long lesions, DES is clearly the choice. The downside of DES stents, as you point out, is the need for prolonged use of Plavix for a year or more (and if you must take Nexium, you should definitely read our coverage of the recent PPI/Plavix reports, "Heartburn Drugs Increase Cardiac Events for Stent Patients by 50%"). So, if a patient is not going to be compliant with Plavix/aspirin, for economic or other reasons, a bare-metal stent may be a better choice. But the question of bare-metal vs. DES is complex and depends very much on the specific characteristics of the blockage, if in fact there is one. We always suggest having these discussions with your interventional cardiologist BEFORE the cath -- and also whether or not you are comfortable with turning the cath into a stenting procedure (known as an "ad-hoc" angioplasty) in the same session, or staging it: doing the diagnostic cath first and then doing the actual stenting in a later procedure. Good luck and let the Forum know what happened.
Angioplasty.Org Staff, Angioplasty.Org, May 20, 2009

• I am scheduled for a cath on Thu after a stress test shows possible blockage in right cardiac artery. Dr said - well DES of course, don't consider the bare metal stent. I am terrified at the thought of being on Plavix for who knows how long. Does this mean I have to stop running around the woods with dogs? What about surgeries? My husband had a plain metal stent in 2003 and has had zero problems. I am reading the DES if they do clot tend to go "WHAM" whereas the plain metal, change in occlusion is seen over time. What to do? where to look? I only have a few days. Also I take 40mg of nexium [2 twice a day] for LERD [worse than GERD] and he did not even mention that!
Nancy, South Carolina, USA, May 18, 2009

• I was hoping to find a answer as to how many stents are too many ? I am 55 year old male, have had 2 heart attacks and open heart surgery. I have 19 stents. Is there some point where you can get too many stents? Also I was just told my my DR. that my heart function has dropped from 55 percent to 35 percent ,Could this be a problem related to all the stents? I will talk to my DR. about this also just wanted your thoughts. Thanks.
Doug, Black River, Mississippi, USA, May 16, 2009

• I have just had a drug coated stent- actually two placed in the LAD artery. I am only 55 years old, this took place about 3 weeks ago and I have returned to work but I am not feeling up to par at all, as a matter of fact I feel worse. Except for the angina which I do not currently experience I feel flu-like and tired all the time. and still have soreness on the left side. I can not lay on my stomach without discomfort. and on occasion feel a sharp pain in my heart that lasts only a split second. I have gone to see my regular MD he says the electrocardiogram looks the same as the day they released me from the hospital, but he would like me to not do any high activity like extended walks for now! SO what is going on!!!!
Peena Carlton, Lakeland, Florida, USA, April 22, 2007

• Bob -- we have not heard or read anything about the matter since we reported on it back on March 5. Waxman's committee has been extremely busy dealing with a number of issues with the Executive Branch and is holding a major meeting next week to discuss the issuing of subpoenas to Secretary of State Rice, Andrew Card, the RNC, etc. We'll try to find out more info -- by the way, anyone can call or email the Committee on Government Oversight and Reform directly. They do work for all citizens. As for the information being of specific clinical help to patients, there's likely nothing there beyond what is already being discussed quite publicly by the medical profession (which we report on regularly). Waxman is investigating the business practices around stents and medical devices. Meanwhile, drug-eluting stent use in the U.S. has dropped since last summer from 88% to 65% of all stents placed -- which is much closer to the levels that are seen in Europe. As we say in all our coverage, whether or not any stent, a drug-eluting or bare metal, is right for a given patient is an individual decision best made in partnership with his/her trusted cardiologist. There are many variables, and it's in everybody's interest that they are understood across the board.
Angioplasty.Org Staff, Angioplasty.Org, April 21, 2007

• Wonder where is the results from Boston Scientific and JNJ to congressman Waxman. I was under the impression it was due 2 weeks from his request. It has now been 6 weeks. Any word on this? There are a lot of us who would like to know. I worry everyday that something will happen and I will have to have another stent or two placed. It would be nice to know these results so that my family will feel at ease if and when this situation arises again, and it will.
Bob Puckett, Snellville, Georgia, USA, April 19, 2007

• Supposedly the Cypher stent has a "nominal elution period" of 90 days, although most of the drug is eluted in the first 30. The Taxus also elutes a controlled dose in the first 30, although, depending on the version used (slow or moderate release) 70-90% of the paclitaxel drug stays in the polymer (is never eluted).
Angioplasty.Org Staff, Angioplasty.Org, March 30, 2007

• How long does the pharmalogical agent in the stent last?
Carrie, Ontario, CANADA, March 22, 2007

• S33 -- We cannot second-guess your cardiologist because he/she has your specific clinical information and test results to judge from, and each patient is different. Most guidelines do not recommend treating blockages less than 50% with angioplasty -- so your case is right on the edge -- but the question is whether the blockage is causing a problem or a symptom, or for some reason is at high-risk for rupturing (a difficult prediction to be sure). What tests have you had to determine the 50% blockage? Also if you have a drug-eluting stent, you will need to be on long term Plavix and aspirin, which may be contraindicated by your ulcer (they cause bleeding). If you are concerned, ask more questions or even get a second opinion, if only to assure yourself that your making the right decision.
Angioplasty.Org Staff, Angioplasty.Org, March 2, 2007

• a 42 yr female who after a regular visit to a cardiologist was diagnosed with a 50% blockage in the LAD..have been advised an angioplasty asap..but the issue gets complicated because i have a duodenal ulcer that has been around for two years . after reading this forum i am terrified as the thought of allergies, clotted stents, re-stenting and am also unsure as what i should go for- a DES or a bare metal stent??
S33, Bangalore, India, March 2, 2007

• Bob -- your doctors are probably concerned because you restenosed within two months and, should you have any problem while traveling, you'd want to be near a place where you can be taken care of. But if you're not sure of the risks and precautions necessary, you should ask your cardiologists because they know your clinical situation better than anyone. Your experience, by the way, is a reason why cardiologists shifted rapidly to adopting drug-eluting stents -- to reduce the restenosis rates seen with bare metal stents.
Angioplasty.Org Staff, Angioplasty.Org, February 21, 2007

• In Dec. 2006 I had two BMS implanted. One in LAD and one in RAMUS. Both restenosed by Feb. 2007. The one in RAMUS could only be cleaned out. The other (LAD) had TWO Cordis DES implanted over the original ones. They actually were longer than the originals. I am taking Plavix and 325mg aspirins..among other meds. The doctors presented the concerns of traveling within the next two months. What are the risks and what precautions should I take?
Bob Murdock, Haverhill, Massachusetts, USA, February 12, 2007

• EMD -- the first bare metal stent was implanted in Europe in 1986; first stent approved in the US was 1994. Stents grew in use from then on -- being used in 80-90% of all balloon procedures. The first drug-eluting stent was approved in the US in 2003, and very quickly the use of bare metal stents fell to about 10-15% of use. Success depends on how you define it. Stents can be "placed" most of the time. The restenosis rate for bare metal stents (closing back up) is about 20%, more in some specific types of cases -- diabetics, for example. Drug-eluting stents have a reclosure rate much lower, below 10% and have been shown to close up far less in cases like diabetics, complex disease, etc. The downside, currently being debated, is the concern over late stent thrombosis, or clotting at the stent site a year or more after implantation. Read our overview article for more details.
Angioplasty.Org Staff, Angioplasty.Org, February 9, 2007

• How long have the bare metal stents been in use and what has been the success and failure rate. Thank You.
EMD, Maryland, USA, February 6, 2007

• To the editor, thanks for your quick response. The ten stents I have had placed are all for new blockages, not for restenosis. In Sept., when I had stent 8-10 placed, the others (drug-eluting) looked fine. The dr. said that for some reason, I have become a plaque-producing machine. Diabetes plays a part, as does heredity and my high triglyceride count which is much better than two years ago, but still high. I take Crestor, Plavix, an aspirin, Cozaar and Toprol XL and the Crestor has improved both cholesterol and triglycerides. I was curious more than anything about the # of stents others have had. The doctor won't even discuss bypass surgery with me because he has practically "rebuilt" my artery system.
Cathy K., Texas, USA, February 1, 2007

• Cathy -- we've gotten postings from several patients who seem to restenose much more than average. We're not MDs and even if we were, can't and shouldn't give medical advice long distance, but we can say that the idea behind drug-eluting stents was to lower the rate of restenosis -- this has been shown in studies to be of benefit to populations at high risk for restenosis, specifically diabetics. Bare metal stents had almost unacceptably high restenosis rates in diabetic patients. Why, in your case, this does not seem to be working is something your cardiologist needs to discuss with you. We assume you are doing everything you can to reduce ALL risk factors, smoking, diet, etc. Are you taking statins for cholesterol? As for a limit on the number of stents, there are people with multiple stents. 10 is definitely a lot. Some would say bypass surgery might be more effective, but that depends on your clinical condition -- bypasses also get plaque buildup over time. What explanation has your cardiologist given you?
Angioplasty.Org Staff, Angioplasty.Org, February 1, 2007

• I just found this forum and wanted to ask a question. I am a 56 yo female, diabetic since 1999, Since February 2005, I have received 10 drug-eluting stents. New blockages appear approx. every six months. I had stent #8-10 on Sept. 12, 2006 and this afternoon while walking in the mall, I started having an angina attack. They start like this and get progressively worse until I have a thallium stress test and wound up back in the cath lab. In 1999, a virus hit various organs including my heart, causing CHF, and my pancreas. The cardiomyopathy has resolved itself, but I don't know if it is related to the plaque buildup or not. I am wondering how many stents a person can have in their lifetime? I am getting discouraged because I do everything I'm supposed to do, I've decreased my cholesterol tremendously in the past 2 years, but continue to gain weight due to the insulin and continue to have plaque build up. Thank you.
Cathy K., Texas, USA, January 31, 2007

• EMD from Texas -- read about collaterals and stents in our news article, "Collateral Circulation in the Coronary Arteries May Be Inhibited by Drug-Eluting Stents". In it Swiss Dr. Bernhard Meier describes his technique of "washout collaterometry", which is simply inflating a balloon, temporary closing off the vessel, injecting a small burst of contrast dye and then watching and timing the contrast dye as it dissipates to reveal collateral circulation.
Angioplasty.Org Staff, Angioplasty.Org, January 23, 2007

EMD, Texas, USA, January 22, 2007

• Alan -- smoking is at the top of the list of risk factors for coronary artery disease. There is no question about it. We realize that stopping smoking, after a lifetime of the habit, is extremely difficult. But you should try to do it -- and you can't really do it alone -- you should find a support group. Will you suddenly block up? The only way to prove that is to run a randomized clinical trial which, given the extensive medical evidence against smoking, will never happen.
Angioplasty.Org Staff, Angioplasty.Org, January 13, 2007

• when i had my 3 drug eluting stents put in my right coronary artery my cardiologist told me that if i continued to smoke it would cause the stents to suddenly block up and could cause sudden death, is this in fact true?
Alan, British Columbia, Canada, January 12, 2007

• Hi, My brother-in-law, working in Dubai, had 4 stents placed, 2 each in LAD and RCA (one each of DES and BMS). Could you explain under what circumstances would a doctor use a combo of these types of stents in the same vessel? Within 4 months, he developed in-stent restenosis in the two BMS's. When he visited India, the doctors put a DES inside the BMS in the RCA. They said the LAD is ok for the time being. He originally had a long lesion in the LAD. What do you think are his chances of needing a CABG in the future? Thanks very much.
Anant Rao, San Jose, California, USA, January 7, 2007

• I would like to give you all an update - I had a fourth DES placement on December 20th, and haven't felt better. I even ran one block to catch a bus on New Year's Eve, and was barely out of breath. My husband told me afterwards that that was my new year's present to him. I don't care if I have to take my meds for the rest of my life.
Shelley Wininger, RN, Brooklyn, New York, USA, January 7, 2007

• Dr. Bhargavaram -- glad to know your a regular reader! As for a prognosis, your cardiologist is the person to ask for that -- every individual is different and your doctor, who can see and test you, will be better able to assess that. But you sound like you're doing the right things (diet is also important and we assume you are a non-smoker). Staying on prescribed medications, exercise and being aware of what your body is telling you are all positive things. Family history is of course a "risk factor", but it is not necessarily "fate" if you take the necessary steps with modern medicines and treatments, which you are doing. Don't shortchange the value of exercise, or of relaxation -- many, including Dr.Dean Ornish, have found that meditation can be helpful.
Angioplasty.Org Staff, Angioplasty.Org, January 7, 2007

• hi, i had a MI involving mid LAD in 2004 june,i am 37yrs old male, i was initially treated with thrombolytics and after one month i,e in july i underwent angioplasty following a cypher DES insertion to my lad. Since then i am on ramipril( ACE inhibitor ) aspirin, plavix and atorvostatin. my cholesterol level is well controlled LDL less than 100. sometimes my ldl below 70 and vldl around 13 - 14. i have a strong family history of mi and death , it runs in my family. i do not have diabetic, hypertension or any other disease apart from this latest mi involving anteroseptal region. my lv function is good , EF - 45. WITH THIS INFORMATION WOULD YOU KINDLY LET ME KNOW MY PROGNOSIS AND THE BEST I CAN DO TO AVOID THIS RESTENOSIS ISSUE. I AM READING regularly, AS WELL HOW lONG CAN I PULL ON, DEPENDING ON YOUR PREVIOUS EXPERIENCES ( REG MORTALITY ). I do exercise on tread mill often as my time permits, basically am an sedentary worker.] i will be greatly relived to know your response in my e- mail. yes one more point , in my angio all other coronaries are well dilated and normal, repeat echo revealed well contracting previous mi scar and less scar with good lv function. waiting for your reply.

• F.K. -- the ACC/AHA guidelines state that for bare-metal stents, only a month of dual antiplatelet therapy is necessary (Plavix and aspirin) but your doctor knows you and has your test results, etc. so you should discuss any questions with him/her and ask for explanations so you know why you're taking something. This information will help you comply better. For example, there may be other reasons besides the stent that he is prescribing Plavix. In fact, the use of Plavix after stenting is technically "off-label" -- see our Editor's blog entry "The Catch 22 of Plavix and the FDA"
Angioplasty.Org Staff, Angioplasty.Org, January 6, 2007

• I recently had two bare stents placed in the same artery, and have been prescribed Plavix, Zocor, Metoprolol and aspirin on a daily basis--My blood pressure is 120/80, cholesterol never exceeds 220: for how long must I take all these medications?? I take vitamins, am 15 pounds overweight (do NOT exercise) and my cardiologist tells me I must take all of them for at least six months, and then continue on Plavix for life!...Any alternatives?? Thanks.
F.K., Florida, USA, January 4, 2007

• I wish we could be an emergency advice hotline, but (a) we don't have the staffing for that kind of response, and (b) clinical decisions like what kind of stent, etc. need to be made by and with your physician who knows you, has your records, etc. Blanket recommendation can easily be incorrect for a particular patient. What we can provide is information. Sun S. -- read our Forum Topic on "Not Feeling Well After Stenting" -- you'll note a number of other patients with similar complaints.
Angioplasty.Org Staff, Angioplasty.Org, January 4, 2007

• I got angioplasty in oct 06 with drug eluting stent cypher in the case of 60% blockage in LAD. But since the angioplasty I am not comfortable and I am having chest pain occasionally . While prior to angioplasty I was not having any chest pain .The cardiologist is not agreeing with my problems and he has put me on medications. Any one with similar case please suggest.
Sun S., India, December 13, 2006

• My father (69 yrs) has been diagnosed with a 90% block in LAD. He does not have diabetes / High BP or any other major ailment. Please advise which Stent he should go in for - DES/BMS. Will appreciate a speedy reply as his angioplasty is scheduled in a couple of days. Thanks
J. S., Illinois, USA, December 13, 2006

• I've posted before about my husband with the 5 Cypher stents. They all occluded within 2 months time and he ended up needing a quad bypass. He was on Plavix right up until the surgery but after the bypass, he was taken off that med. He is now only taking baby aspirin (no other blood thinners). With all of the recommendations for patients to stay on their Plavix after DES stent insertion, we are very concerned. What is the recommendation for some one in his situation? Is there a risk that some of these clots can travel and cause a heart attack or stroke?
S., Massachusetts, USA, December 11, 2006

• Shelley from Brooklyn -- good luck and let us know how you made out. And C. from Ohio -- what you describe, multiple stents, is an "off-label" use and the FDA does not regulate off-label use -- it's up to the doctors and the FDA does not want to get into regulating what doctors can or cannot do -- unless there is a definite public health hazard, which they have determined is not the case with drug-eluting stents, at least right now. Most panel members (and I'm sure the FDA will issue a statement on this soon) felt that one year of Plavix/aspirin is a good idea, some felt for life if there is no bleeding risk. Some studies have shown that Plavix has little effect beyond a year (some say six months) but none of this is clear.
Angioplasty.Org Staff, Angioplasty.Org, December 11, 2006

• Did the FDA decide on the recommended duration of use of Plavix + Aspirin following placement of up to 5 drug-eluting stents? Also, how long is a stent like this considered eluting? Also, is there a time when a patient may feel "home free" (i.e. 4 years???)
C., Ohio, USA, December 10, 2006

• I am a 55 year old woman who underwent 3 DES placements on September 5, 2006. All pretty much went okay, and I took my Plavix and Aspirin religiously (I am also an RN, and I know the problems with non-compliance). On December 5th, 3 months to the day later, I felt tightening in my neck while walking in the cold. Since both my mother and brother also have stents, I don't take anything lightly. I got home from work and told my husband to take me to the hospital. All the tests were negative, so I went home and saw my cardiologist 2 days later. My stress test was positive, and my angiogram that same day showed a 60% blockage. I was told that it probably happened because when they put the first stents in, it was on an emergency basis, and they apparently missed stenting all of the areas that they ballooned, and it has since closed up.The plan is to put another stent in on Wednesday, overlapping the previous stent. Whether it will be a DES or BMS, I have no clue. Reading the responses, I think a DES is called for. I agree that compliance of medications is very significant in studies with negative outcomes.Wish me luck.
Shelley Wininger, RN, Brooklyn, New York, USA, December 9, 2006

• It's amazing what a difference a year can make in the world of health and science. In August of 2005 I posted on the forum while I was in the midst of a reaction to my Taxus stent. My symptoms subsided after 3 months. I underwent a multitude of tests and consulted with my internist, an infectious disease specialist (my reactions were fevers, nausea and fatigue), and my cardiologist. At the time of my post, there was very little information on DES reactions. It took a lot of talking, and persistence on my part to convince my cardiologist I was having a reaction. The response I got from the forum editors was also luke warm at best. I'm glad to see that more attention is being directed toward DES reactions. While the percentage DES reactions is statistically low, the effects of these reactions can be severely disabling to the persons experiencing these reactions. There needs to be better screening in place to identify patients that have the potential to react to the DES, and better treatment options when the reactions occur. I want to thank for the progress it has made in providing people with current, accurate information regarding DES reactions. I'm also glad to see that there will be an opportunity for patients to participate in studies related to DES reactions.
Gwynne Hannum, RN., B.S.N., C.C.M., C.H.P.N., Chesterfield, Missouri, USA, December 8, 2006

• Terry, sounds about right. Here are the current AHA/ACC guidelines from the American Heart Association / American College of Cardiology:

  • Start and continue clopidogrel 75 mg/day in combination with aspirin for up to 12 months in patients after acute coronary syndrome or percutaneous coronary intervention with stent placement (=1 month for bare metal stent, =3 months for sirolimus-eluting stent, and =6 months for paclitaxel-eluting stent).
  • Patients who have undergone percutaneous coronary intervention with stent placement should initially receive higher-dose aspirin at 325 mg/d for 1 month for bare metal stent, 3 months for sirolimus-eluting stent, and 6 months for paclitaxel-eluting stent.

Angioplasty.Org Staff, Angioplasty.Org, December 8, 2006

• Well finally new Stent fitted yesterday to RCA blockage. A DES fitted (endeavour) so now i have one of each. Unlike last time I have been put onto 300 mg Aspirin and 75 mg Plavix, with the aspirin at this level for 6 weeks then back to 75mg/day, this is in addition to Warfarin for my AF. Is this amount of Aspirin +Plavix now normal for stenting?
terry, UK, December 5, 2006

• No, the coating does not wear off the currently U.S. approved drug-eluting stents. (Newer stents in trials, like the Conor CoStar, purportedly will have this happen.) That is why it is important to take the antiplatelet medications (Plavix or Ticlid) and aspirin for an extended period. No. There are no real tests to tell if the artery wall has healed over the stent. Nothing that's non-invasive. The FDA is going to be discussing these issues in a big two-day meeting starting Thursday. Stay tuned.
Angioplasty.Org Staff, Angioplasty.Org, December 5, 2006

• My husband 46 years old received a coated stent on 11/10/06 . We were not given a choice of medicated or bare & want to know if after time does the coating wear off and becomes bare stent ? Are there any tests that can determine if the artery wall has healed over the stent ?
Mary, Naperville, Illinois, USA, December 5, 2006

• ASF -- you and your cardiologist seem to have zeroed in on the likliehood that you are having a reaction to the stent -- and the cardiologists we have talked to concur that it is most likely the polymer which is the culprit. We have also heard that the polymer, even though it is "non-biodegradable", begins to break down after a year or so. The possible good news here is that the allergic symptoms should at that point subside. We'll be sending along the information you requested about the research being done to determine stent hypersensitivity. As for a surgical extraction, that's not really an option. The stent becomes part of the arterial wall and that can't really be excised.
Angioplasty.Org Staff, Angioplasty.Org, December 2, 2006

• After six months, my cardiologist has conceded that my problems point to a compromised immune system and she is unsure at how to proceed and is seeking another referral for me to a larger center in L.A. where they may have some experience with difficult patients like me. She likened my condition to those women who had defective silicon breast implants. The first step in every breast implant patient was to remove the offending product and I firmly believe we have to consider the same action with these DES implants. I have seen two allergy specialists and although they have no experience with DES patients, they essentially reiterated the same information that TB of Ohio, USA posted on June 24, 2006, the prognosis for people who are hypersensitive [is] the stent will close and the outcome is probably death. Why is no one even entertaining the possibility of a Coronary Endarterectomy or bypass as a solution while I'm still healthy enough to recover ? We re not talking about the more common occurrence of thrombosis or in-stent restenosis, which the medical community understands and generally deals with successfully. My hypersensitive reaction can be controlled with prednisone but my doctor has been lowering my dose weekly (this is the second time we've run this course trying to desensitize me to the stents) and as the does falls below 8mg the problems start. Since prednisone is only a short-term solution (treat the symptom not the problem) we need a better solution, a surgical solution that addresses the problem directly.

I freely admit being a hard ass about this issue. But it s my life and quality of life that has been compromised. In 48 years, I have never been sick, under a doctor's care or admitted into a hospital prior to this. I went into the hospital with a minor chest pain, which I normally managed with Ibuprofen. I was on the operating table when they said they were going to have to take intervention for 99% blockage. I understood this to be stents and only having heard only positive results about stents, I was not concerned. I have reviewed your blogs on DES problems and I share most of the problems reported, including allergic reactions or severe side effects to almost every drug therapy prescribed. Although at this point my suffrage has not been as severe as some of the other lucky DES recipients, how does it make any sense to wait until my health has deteriorated as a result of my weakened immune condition or I have been compromised by some other aliment that we take.
ASF, California, USA, November 30, 2006

• To S. of Massachusetts My understanding of the DE stents is they are compromised of three components, the stainless steel mesh stent, the polymer coating and the drug eluding component (paclitaxel for Taxus stents). The drug-eluding component is short lived ( weeks or months ?) leaving the polymer coated steel stent. Assuming the stents are not defective, the stainless steel is wholly encapsulated by the polymer. In theory it s impervious to chemical components found within the human body. So the reasonable conclusion for people experiencing long term and escalating problems, is an allergic reaction to the polymer. As my cardiologist has now concludes, my compromised immune system is exhibiting symptoms very similar to the condition of women who had defective silicon breast implants. But I have also found some conflicting information (big surprise) on the polymer. There are some medical professionals who believe the polymer is not impervious and that it will dissolve over the course of several years. That introduces another variable as the polymer dissolves it becomes porous and can harbor bacteria leading to arterial bound infections.
ASF, California, USA, November 30, 2006

• To A.S.F of California. My husband still has his 5 stents. If I had suspected he might be allergic to them back when he had his bypass, I might have asked to have them removed at the time of his surgery (though I'm not sure they would've obliged.) I'm guessing that my husband was allergic to the drug and/or polymer on his stents, because his reaction did eventually subside after a couple of weeks (assuming the drug and polymer are time released). I have heard of people being allergic to stainless steel (joint replacement issues). Perhaps that might be your problem. You should be able to have that confirmed with a visit to an allergist. Good luck!
S., Massachusetts, November 29, 2006

• M. -- did you read our editor's pointed reply to the NBC article in his blog -- it was featured on our front page, called "Eensy Weensy Time Bombs". Enjoy.
Angioplasty.Org Staff, Angioplasty.Org, November 29, 2006

• NBC continues to scare us with Robert Bazell's stories on drug eluting stents...Wish someone would come up with a reply to these...I think he makes much too much of the dangers.
M., Texas, USA, November 29, 2006

• The Forum has been on a short hiatus this month, so let me try some quick replies (remember, none of these comments should be consider "medical advice"; only an M.D. is qualified to dispense that).

To both A.S.F. in California and S. in Massachusetts, you have company in your reported allergic reactions to drug-eluting stents. On the right-hand sidebar, you'll note a Forum topic specifically on that issue. There has been very little discussion of this and the instances are definitely under-reported, if reported at all. The Forum on Angioplasty.Org is in fact one of the only places on the Internet where you'll even find a mention of stent allergy or hypersensitivity. Angioplasty.Org has just teamed with a group of university-based researchers who are about to launch what will be a significant study of this phenomenon, and they are looking for patients who feel they have experienced an allergy to drug-eluting stents. For more information, email us at (...and A.S.F., as S. just posted, stents, once implanted cannot be removed -- they become part of the artery. The blood clots we've been hearing about are called "Late Stent Thrombosis" and they occur in and around the stent itself.

By the way, "occluded" merely means the artery is blocked. Restenosis is a process whereby the area closes up again as endothelial cells grow to heal -- it's an over-healing, a process that drug-eluting stents were created to stop, and they've been pretty successful. Stent thrombosis is a completely different thing where thrombin and platelets in the blood very quickly gather and cause a blood clot -- this does not happen over time, but rather it occurs acutely, often causing a heart attack. Hope this clarifies things.

Gordon in Tennessee, we hope your angiogram went well (and hopefully you didn't need ANY stents). We were unable to reply to you within your short time frame, but we hope you read our Patient Advisory (again in the right-hand sidebar) which discusses your situation -- we really have nothing more to add to that. Let us know how you fared.

D. in England -- we just posted a feature article on the role of IVUS in stent thrombosis. Give it a read.

Finally, Kim -- your father's situation is one which we are very concerned about. Angioplasty with or without stents has been a great life-saver specifically in the role of stopping or limiting the damage to the heart muscle from a heart attack. But with drug-eluting stents, a new problem has arisen -- emergency patients may not be able to tell the cardiologist of any known allergies, for example, your father's case. Other patients are allergic to Plavix; a small number to the stainless steel or nickel in the stent; yet more, as you can read above, may have an allergy to the polymer coating on the stent. The problem is that many of these reactions aren't predictable prior to stent implantation. So patients who cannot tolerate the required antiplatelet therapy, etc. wind up with a drug-eluting stent. Of course, bare metal stents also require antiplatelet therapy, but only for 4-6 weeks, not 6-12 months. We're hoping the FDA panel next week will resolve some of these questions with some much-needed recommendations.

And to all, please remember that the Forum is run by a volunteer staff -- and while we try to keep postings up to date, our traffic has increased almost 40% in the past few months, due mainly to the concerns about stents. We appreciate any donations from our readers to help keep it going.
Angioplasty.Org Staff, Angioplasty.Org, November 28, 2006

• My father-in-law was taken to er with chest pains. He was suffering a heart attack and he received the medicated stents. This is a problem because he cannot tolerate aspirin due to severe heartburn/reflux. Should he have been given the regular stents rather than the medicated? Family members were not given options of one or the other, possibly due to the emergency situation? He suffered another attack within a week, taken to er, blood clot in the brain was discovered. He was doing better and was given a release date when another heart attack came on. Any advice or options greatly appreciated.
Kim, Virginia, USA, November 28, 2006

• Has anyone any idea the role IVUS can play in reducing this problem?
D., England, United Kingdom, November 14, 2006

• I am 38 and my doctor is performing an angiogram in a couple of days. Quite frankly, I am terrified after reading this forum. Assuming I have a choice, what should I choose...DES or BMS? My dad had two stent failures and I want to make the best choice I can. I have a lot of life left I would like to live. What would you choose? Anyone?
Gordon M., Tennessee, U.S.A., November 8, 2006

• If the stent is "occluded" is that the same as restenosis? Can an occlusion be the result of an allergic reaction to either the drug or polymer coating on the stent? I've posted before in this forum but don't seem to get any response to any of my questions. My husband is the one with 5 stents (DES), all of them having occluded (within 2-60 days), resulting in his having to have a quad bypass. He no longer takes Plavix and is on Lipitor, Toprol XL and baby aspirin only. Since the stents cannot be removed, is there a risk of any of the clots in the stents moving and traveling throughout his circulatory system? He seems to be doing OK now - his next appointment is not until Jan.
S., Massachusetts, USA, November 8, 2006

• To: S., Massachusetts, USA, on her October 11, 2006 posting - Were the stents removed during your husband's bypass surgery ? I have 3 DES stents and continue to [have] allergic reactions to them. I am running a second round of prednisone, which is controlling the symptoms. But as the prednisone is being reduced, I am experiencing the problems returning. I told my doctor I want them taken out. She's quite adamant that that is not an option (and the blog Editor here has also avoided answering that question directly numerous times). My concern is that my allergic reaction and my body's continued effort to fight these foreign bodies is wearing down my body's natural immune defenses. In a weakened / compromised immune condition, it may not be the stents that catch me, it may just some other more common illness such as the flu or pneumonia.
A.S.F., California, USA, November 3, 2006

• Andrea -- when a stent restenoses (the blockage recurs due to build up of cells) it's called "in-stent restenosis" (ISR) -- if the blockage is significant enough to be causing problems or angina, the blockage can be reopened using a balloon. Often cardiologists insert a second stent inside of the first. This is technically an "off-label" use, although several studies have been published showing that this seems to be a safe and effective treatment, and in these trials has performed better than bracytherapy (radiation) which was previously thought to be the best treatment for ISR. What are the risks of a third stent? The answer to this is specific to your mother's case so, as always, these questions should be discussed with your mother's cardiologist (see our article on "You and Your Physician" for suggestions on accompanying her to the appointment). We would repeat that your mother is at high risk for restenosis, so is one of the patient population best served by DES. Let the Forum know how it goes.
Angioplasty.Org Staff, Angioplasty.Org, October 28, 2006

Angioplasty.Org Staff, My mother had a second stent placed inside of her first stent. Apparently the Cardiologist told her that "both ends of the mesh fell & bent down". He has also mentioned that she has extensive scar tissue. How does a stent get clogged in less than 90 days? I just wonder if the DES is the best fit for her situation. She has a fairly well known Cardiologist at UCLA so I just hope he knows what's best for her. Do you know what risks are associated with having a third DES stent put in? She is going to ask him about the IUS. Thank you so much for your input.
Andrea, East Bay, California, USA, October 27, 2006

• Andrea -- sometimes a stent will restenose (reblock). This is different from blood clotting -- scar tissue is one way to think of it. We're not clear if the two stents she currently has are in the same place -- did the first block up and was the second used to reopen it.? Or are these two stents in different parts of the same artery? Remember, stents and balloons are only mechanical fixes. They do not cure or prevent coronary artery disease. Lowering risk factors is one thing patients can do (smoking, diet, exercise) but until an actual cure is found, the disease can continue. The fact that she has already restenosed would tend to put her in the category of patients who would benefit most from a drug-eluting stent. Remember the concerns about safety are rare events. And it is believed that a good portion of these events occurs when patients prematurely stop their Plavix and aspirin. Some physicians might do an IVUS (intravascular ultrasound) on the artery to get a better idea of what's going on.
Angioplasty.Org Staff, Angioplasty.Org, October 27, 2006

• My mother is 54 years old and has had two Drug-eluting stents put in, the first in November 2005 and the second in July 2006. Now only three months later she just found out that the same artery is clogged again! She has increased her exercise, changed her diet, and lowered her stress levels to a point they have never been at. Keep in mind she does have a history of blood clots. Does anyone have any information for me as to why her same artery is clogged again? The Cardiologist says it is likely "scar tissue". I am afraid for her to have a third drug eluting sent put in. Apparently something is wrong! Any input would be appreciated. Thank you.
Andrea, East Bay, California, USA, October 27, 2006

• Kent -- you and many cardiologists are confused. There were several panels that we saw at this week's TCT meeting, and the general consensus seems to be, Plavix at least one year, but some think that if their patients can tolerate (and pay) for the drug, they should stay on it longer, assuming they don't need surgery and that they are not having bleeding problems -- at least until more data become available. Recent reports are very confusing. The FDA has announced a major open meeting to be held on December 7-8 and this very important subject will no doubt be discussed. You're almost two years out, which is pretty long.
Angioplasty.Org Staff, Angioplasty.Org, October 27, 2006

• I had a heart attack December 30th 2004 at which time I had 2 Taxus2 drug eluting stents implanted. I was on the Plavix and Aspirin combo for 1 year afterward and now take only 1 aspirin 325mg daily. With the new information about late stent thrombosis I and concerned that I was taken off Plavix after a year. My Cardiologist says that I should be ok without the Plavix but I wonder if anyone knows when the danger of late stent thrombosis passes after drug eluting stents are implanted. Also I have had 3 regular stress tests but no nuclear stress test and wonder if this is the norm with other patients on this forum?
Kent H., Georgia, USA, October 26, 2006

• Charles -- as we state in our overview on DES, there are three components: the metal stent, the plastic polymer coating, and the drug embedded in the polymer. Over 6 months or so, the drug elutes from the polymer to prevent restenosis. Then its job is done. But in the two DES currently on the market in the US (Cypher and Taxus) the polymer is permanent -- it stays. The concern is that something still prevents complete healing in some individuals and pathologist Renu Virmani has photos of DES that still have struts uncovered after two years. This would be a cause of thrombosis or clotting. After the drug is eluted, a DES is NOT the same as a bare metal stent -- it still is covered with a polymer. In the Conor stent and other new emerging devices, this whole process works differently, with various stages of bioabsorption. There are theories about why late stent thrombosis occurs, but no one yet knows for sure. Hope this clarifies things.
Angioplasty.Org Staff, Angioplasty.Org, October 26, 2006

• I guess I still don't understand completely the response from the Forum Editor to N from Colorado on 10-3. If the DES emits all its medication by 6 months or even a year, and if the remaining polymer on the stent is the same as the bare metal stent, then why all the concern at Barcelona over late thrombosis occurring after say 1 year? Would not the drug eluting part of the stent be a non-issue after a year? Is there some other delayed mechanism at work? Clearly the conference at Barcelona found statistical data to suggest an increase risk (even if small) between the 2 stents. But if there is no physical mechanism suggested for the increased late thrombosis is all the concern just statistics? Thanks
Charles, Illinois, USA, October 24, 2006

• Hi everyone, this is my third post after October 1, 2006 . I just wanted to thank the forum editor and update everyone on my mom's case. She has just come back from the hospital after going through a heart catheterization procedure to see why she failed her stress test. The result is that all her arteries are clear. Even the main one with the cypher stent is still clear. The final conclusion was that she experienced a false positive result with the stress test, just as the forum editor proposed as a possibility. Thanks again for giving me that possibility. Knowing it is fact now is more of a comfort than you can imagine, after dealing with so much anxiety for the past couple of weeks. Conclusion: Every woman over the age of 50 please be aware of this possibility. You CAN have a false positive stress test and your cardiologist may not think of telling you about it. Good luck to everyone here!
Rima, October 19, 2006

• After suffering a heart attack at age 47, my husband had a Cypher stent inserted. Two days later, they attempted to open up a second 90% blocked artery and discovered that the first stent had clotted. The doctor inserted 4 more stents to reopen the vessel. They never got to the other blocked artery. He also had a third artery that was 30% blocked. He was put on Plavix, 80 mg Lipitor, Lisonopril, Toprol and full strength aspirin. Two weeks after this episode my husband suffered an allergic reaction. They had him eliminate the Lisonopril but he stayed on all of the other meds. He was treated with prednisone and after a couple of weeks the reaction subsided. Two months later, when they again attempted to open the 90% blockage, they found that all 5 Cypher stents had clotted. His 90% blockage was now at times 100% blocked and his 30% blockage was now over 80% blocked. He had to have an emergency quad bypass. My point is this - he never came off of any of his meds other than the Lisonopril, yet his stents clotted severely. His other arteries also appeared to become more inflamed as well. My theory is that he was allergic to the Cypher stent (med and/or polymer). Insertion of 5 stents was an overload to his system. Bypass surgery was not a consideration when he had his first heart attack. Yet, 2 months and 5 stents later, the bypass is what kept him alive. Can some of these instances of clotting be in response to an allergic reaction to the stents themselves? Should candidates for DES's be tested for sensitivity to the polymer and drugs on the DES? My husband does have a history of allergies. Perhaps his outcome would've been different had they used bare metal stents rather than the DES.
S., Massachusetts, USA, October 11, 2006

• I had two Taxus drug coated stents put in 20 months ago--I was put on Plavix (for a year), Aspirin, Toprol (though I don't have high blood pressure), and Zocor forever! I take several walks each day. Have passed two nuclear stress tests with flying colors! I have no chest pain. I breathe with ease--better than ever! Guess I have to say that all the news about the stents does concern me--but I am so satisfied with the way I feel. I just am not gonna worry!
M., Texas, USA, October 3, 2006

• N. -- actually our overview article on drug-eluting stents (right-hand column) discusses the various components of DES. On the two currently approved for use inside the U.S. (Cypher and Taxus), the drug is embedded in a polymer (plastic). The bare metal stent base is coated with this polymer. The drug is timed to dissipate (or elute) over a 3-6 month period, but the polymer remains permanently. It is thought that the polymer may be the culprit in the healing process. Conor Medsystems has a novel drug-eluting stent, named the CoStar, which is approved in Europe and they hope in the U.S. in the next year or two. This stent uses a bioabsorable polymer which does exactly what you are talking about -- after six or so months, the drug AND the polymer dissipate and the stent becomes a bare metal stent. Many cardiologists believe newer stents like these, or ones that are completely biodegradable, are the future.
Angioplasty.Org Staff, Angioplasty.Org, October 3, 2006

• I had a Taxus stent implanted in July and was curious to understand why a drug eluting stent does not 'turn into' a bare wire stent after the drugs have been completely dissolved. If all the drug is dissipated, why would the stent not revert to the statistical profile of late stage thrombosis for a bare metal stent? I have not seen this addressed in any of the discussions. My cardiologist told me that all of the medication had dissipated from my stent. Inquiring minds want to know...
N., Colorado, USA, October 2, 2006

• Rima -- stent thrombosis is an acute event: the blood begins to clot, it obstructs the normal flow of blood and almost always results in chest pain and sometime a heart attack. When it happens, it happens quickly, very similar to a heart attack. Restenosis, which is the slower process of plaque building up to the point where it is obstructing blood flow, is a completely different process. While there have been recent reports and concern about late stent thrombosis with drug-eluting stents, and some of this can be traced to non-compliance with antiplatelet meds, these same coated stents have been responsible for reducing the restenosis rate significantly (from 15-20% down to 5-10%) -- but restenosis can still occur. If the stent has gotten reblocked (called in-stent restenosis) it can be reopened, sometimes with a simple balloon inflation, sometimes with a second stent inside of the original (this is considered officially an off-label use, but trial results have shown it to be an effective therapy). So the difference between restenosis (reblockage from plaque) and thrombosis (sudden acute blood clots) is very important -- bare metal stents may cause less late stent thrombosis but they definitely have a much higher restenosis rate. What is important is that your mom has been compliant with her Plavix and aspirin. It's possible that she has a blockage in a different place. It is also possible that the stress test was a false positive (something that occurs more in women than men). Please let the Discussion Forum know the outcome. Thanks.
Angioplasty.Org Staff, Angioplasty.Org, October 2, 2006

• Hi everyone. My mom had a drug-eluting stent placed in her main artery one year ago. She goes in for her annual check up and ends up failing her stress test. She is scheduled for an angioplasty next week. Her cardiologist told her he believed her Cypher stent had caused late stent thrombosis or another clogged artery may be the case. But here is the deal. She hasn't stopped taking plavix or aspirin. She walks everyday, is on a constant diet and she never quit her medication. Could she be the 1% in 100% ? When will we have a complete study that tells patients what to do? Should she choose a Bare metal stent next time and risk restenosis or choose DES and risk thrombosis? Can anyone please comment?
Rima, October 1, 2006

• Terry and others -- the latest news has caused much controversy in the interventional cardiology world. Check out our "Patient Advisory" on what the news means for patients.
Angioplasty.Org Staff, Angioplasty.Org, September 27, 2006

• With the latest news (Sept 2006) ref DES problems, what would be the choice for patients now? I was fitted with a Bifurcation BMS in jan 2006, and have just had a further Angiogram to determine the cause of my ongoing chest pains on exertion. They found that the BM stent was performing well and was not the cause of my problems, but more likely the lesion in my RCA. Which was known about from my first angiogram, but not stented. Question is now, Do I ask for a BMS or DES? I have been taking Plavix/Aspirin combo since stent placement Any replies appreciated.
Terry, UK, September 27, 2006

• Dear Forum editor ...thanks for the prompt reply but when you say "having them prematurely discontinue antiplatelet therapy"....I have been on it for one year therefore my question is stopping it for just one week prior to the endoscopy, could that even be considered as premature?
Rick, New York, USA, June 27, 2006

• Rick -- look at the cardiologist's post below yours, specifically at reason #5 why DES sometimes clot off more than BMS. Don't go off your meds without consulting your cardiologist first. This is a major patient and physician education problem. Cardiologists know about this, but doctors in many other specialties do not realize the risk they are subjecting their patient to by having them prematurely discontinue antiplatelet therapy, even for a short period.
Angioplasty.Org Staff, Angioplasty.Org, June 26, 2006

• Had 4 DES stents placed in LAD -- cardiologist has me on Coumadin as well as Plavix but no aspirin at all. Coumadin was for an AFib problem. For a time when I was off of coumadin he put me back on the Plavix and aspirin combo. Assume that if one is taking Coumadin and Plavix the aspirin is indeed not needed. Am scheduled for an endoscopy and was told to be off the plavix / coumadin for one week prior. Assume that if i resume medication after one week I will be safe or is there a danger of being off the meds for a period as short as one week?
Rick, New York, USA, June 26, 2006

• I raised this issue in the Health section of a private stock trading forum. One of the traders is a cardiologist and replied like this, which I think might be of interest here:

I doubt the Swiss study will amount to anything.

Drug-eluting stents (DES) are far better than bare metal stents (BMS) in preventing the biggest issue with angioplasty--renarrowing or restenosis due to scar tissue buildup over the first 6 months after the angioplasty.

In fact, the DES are sooooo good at preventing restenosis, that sometimes, even after 6 months, portions of the metal of the stents can be naked and exposed to the blood as it flows through the artery. Conversely, the bare metal stents almost uniformly have rapid growth of tissue covering all exposed metal within 4 weeks. Well, metal in contact with the blood is what triggers clotting of the stents. This is why all patients getting stents are placed on a combo of aspirin and plavix. With the BMS, this is for 4 weeks, since after that, the metal is already covered with a thin layer of scar tissue.

With the new DES, since they are so great at preventing scar tissue, you have to take the combo aspirin and plavix to thin the blood for a bare minimum of 6 months, preferably a year, and many for more than 1 year or even indefinitely.

Given a choice, hands down, I would want a DES over a BMS any day.

Here are the reasons why DES sometimes clot off more than BMS.

1. Patients forget to take the pills
2. Patients run out and figure they can wait till the next appt to renew.
3. Patients decide to stop taking it because they are bruising too much without checking with their doctor.
4. A receptionist at the dentist's office tells the patient to stop aspirin and plavix
5. Someone in a gastroenterologist's office tells a patient the same thing before an endoscopy
6. Some patients are resistant to aspirin or plavix.
7. Primary doctors sometimes take the patient off because of bruising or lack of understanding.

Anyway, in the end, taking the time to explain to patients that have just received a DES the need for uninterrupted dual anti-platelet drugs for at least 1 year goes a long way. I tell my patients that there cannot under any circumstances be another person on the entire planet that can direct them to stop either drug without discussing it with me first, unless there is a life-threatening bleeding problem. End of story. My patients listen when I put it that way. Then they enjoy the wonderful low risk of restenosis from scar tissue compared with the alternative:

plain old balloon angioplasty: roughly 30-50% restenosis.
BMS: roughly 20% restenosis
DES: less than 10% restenosis.

K., Ohio, USA, June 25, 2006

• after what time period is one safe....i.e. if the stent thrombosis hasn't happened within a year is it likely that it won't happen?.....
Rick, New York, USA, June 23, 2006

• Tom -- you raise an interesting and timely question. It is the subject of a major article in today's Wall Street Journal, and it is one that we have been discussing here at Angioplasty.Org for quite some time. Your concerns are certainly valid. In fact, they were mirrored in a quote from prominent interventionalist Dr. William O'Neill of Michigan's Beaumont Hospital in response to a study presented at this March's American College of Cardiology meeting. The risk of sudden severe blood-clotting, called " stent thrombosis", has been measured in the various clinical trials that have been done as the basis for FDA approval of all drug-eluting stents. The incidence of stent thrombosis in these studies has been small, less than 1 in 100, the same as bare metal stents. However, in clinical trials, compliance with the prescribed antiplatelet medications tends to be pretty high. In the real world, most doctors suspect compliance is lower. Last Monday a study published in Circulation reported a shocking finding: 1 in 7 heart attack patients with drug-eluting stents stop taking their prescribed antiplatelet meds within the first month and in that group, mortality increased 10-fold. We are working on a feature article about this whole area and will post a link here when it's online. Meanwhile, we'd very much like to hear others' opinions on the issue of drug-eluting stents and the required antiplatelet medications. (You might also want to check out another Forum Topic on "Plavix and Aspirin".)
Angioplasty.Org Staff, Angioplasty.Org, June 22, 2006

• Drug-eluting stents apparently have much less long-term restenosis than bare-metal stents, (and that is good ) but in turn, aren't they subject to sudden severe blood-clotting in a few cases, causing massive heart attacks, epecially if one quits taking Plavix, (and that sounds bad ). So doesn't it sound like we're trading a serious stomach ache for many patients for a possible very serious headache for a few patients? Does anyone have any input on this?
Tom T., Arizona, U.S.A., June 7, 2006

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