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Current Postings on This Page (134):

• my father had undergone angioplasty on 27 march 2012 on 10 April he again was admitted for chest pain ,in diagnose and check angio blood clot was confirmed , after doctors treatment clot is bursted, seeing the critical blood sample were send for lipoprotein and homocystine results found homocystine was 3 times normal limit. mean time re angio confirmed clot again in no time doctor placed a stent under stent to avoid clot ........................kindly suggest the treatment and comment on the process doctor taken please advice
mukesh, India, April 16, 2012

• Hi this is Hopeful in Georgia you are correct about 2 days after my post the pain stopped, which made it about 6 weeks after stenting. I haven't had any more pain since that time. I even walk on my treadmill and is fine, so may there is hope for us all!!!!!!!!!!!! Thank You, Hopeful
Hopeful in Georgia, Buford, Georgia, USA, April 1, 2012

• Hopeful in Georgia -- You've posted to a topic on stent thrombosis. Check out a more appropriate topic, "Not Feeling Well After Stenting". You'll find that various pains after stenting in some patients are not uncommon, but they do go away with time. The question is whether these pains are angina and whether something is amiss with the stent that was placed. If you suspect this or are concerned in any way, consult your cardiologist, if only to rule out anything serious.
Angioplasty.Org Staff, Angioplasty.Org, March 20, 2012

• I had a stent in Oct. 2011 it collapsed another in Feb 2012 am still having chest, jaw, arm,and shoulder blade pain. At first it was every day real bad now I am having skip days without pain but it comes back. I mean one day none the next pain again. Anyone know if this is normal and will the angina ever go away????
Hopeful, Buford, Georgia, USA, March 14, 2012

• HA from Saudi Arabia -- The answer to your first question depends upon the specific stent. Our interview with Dr. Giulio Guagliumi discusses this very issue, and specifically refers to the ODESSA clinical trial he conducted, measuring stent strut coverage at six months, using Optical Coherence Tomography (OCT). The Endeavor stent had almost 100% coverage, better even than bare metal stents -- however because it showed more tissue growth, it also showed more neointimal hyperplasia, tissue growth inside the stent which may or may not have clinical implications for restenosis. The Cypher stent had the most uncovered struts, more than 8%. We are looking forward to continuing information on the newer stents since that trial was conducted. As for a medical test for coverage, that would be OCT -- however, this can only be done during an invasive catheterization procedure and, even then, it's not 100% clear if the tissue covering is actually endothelial cells or fibrin.
Angioplasty.Org Staff, Angioplasty.Org, March 12, 2012

• How long does it takes for tissue to cover DES ? And how we can get reassurance that DES is now covered (Medical tests)?
HA, Kingdom of Saudi Arabia, March 10, 2012

• vmaxdude2000 in Rochester -- Although your post is a bit off-topic (not about stent thrombosis) there is no question that a proper diet is of great importance -- would that patients with significant coronary artery disease could reverse all that with diet. But modern medications have worked wonders in reducing the progression of heart disease and, when they aren't enough, intervention with balloons, stents or surgery. That being said, diet, exercise, stopping smoking -- these are all extremely important in reducing the risk factors that are under our control.
Angioplasty.Org Staff, Angioplasty.Org, February 9, 2012

• Everyone here should read the best seller Eat to Live, by Dr. Joel Furhman. It's your diet that is killing you! Change your diet and reverse heart attacks and diabetes and get off the medication. Trust me get this book and you will understand. The medication you are taking is treating the symptoms not the cause. The money you save by not taking medicine you can use to by fruits and vegetables. NUTRIENT DENSE FOODS! IT'S simple. Plus will you will lose a ton of weight.
vmaxdude2000, Rochester, New York, USA, February 9, 2012

• Patty in Florida -- Were you prescribed Plavix after a stent was implanted? If so, when was the stent put in? After a drug-eluting stent, patients should take Plavix for one year. This is to prevent stent thrombosis (a blood clot inside the stent, which can cause a heart attack). We urge patients not to change any medication without consulting their cardiologists. Easy to say, but in the U.S. healthcare system, not always possible, as your story shows. Check out our Forum Topic on "Financial Assistance for Plavix and Other Prescription Drugs" -- you might find some help there.
Angioplasty.Org Staff, Angioplasty.Org, February 1, 2012

• i have went off Plavix due to not enough money lately. my concern is now when i refill my Rx will i have a problem with it. I'm really worried. can anyone help ease my mind. thanks.
Patty, Fort Meade, Florida, USA, January 30, 2012

• msm8143 in Virginia -- Clotting inside the stent (stent thrombosis) is an acute event. In other words, it happens quickly and the resulting event is pretty immediate and usually an emergency situation. If you read our Topic on "Not Feeling Well After Stenting", you'll see a number of posts relating to pains after stenting. Some of these will go away in time but, as we always recommend, if you are concerned or especially if the pain feels like the angina you had prior to stenting (and you are describing that) you should contact the interventional cardiologist who did the procedure and discuss this issue. And keep the zforum updated on what you find out, so others may benefit.
Angioplasty.Org Staff, Angioplasty.Org, January 18, 2012

• I had a stent inserted 4 weeks ago and felt better than I have in years. I have been on Plavix and 2 baby aspirin daily. However, the last week I have had intermittent episodes of the same chest discomfort and dyspnea I had prior to the angioplasty. I finally took a nitroglycerin tab yesterday that relieved the discomfort for about 30 minutes. I can't imagine the stent would have clotted and there were no other areas with any blockage. I don't want to take any chances but don't want to undergo another cath if it isn't necessary.
msrn8143, Virginia Beach, Virginia, USA, January 18, 2012

• Lance from Miami -- how long ago had you gotten your second most recent stent before you stopped the Plavix? And what type of stent was it (Brand name if you know it)?
Angioplasty.Org Staff, Angioplasty.Org, January 7, 2011

• I recently had another stent put into my RCA (right coronary artery) that makes number 7. I had stopped taking the plavix for approximately 3-4 weeks and I developed blood clots in the artery and had to have a stent put in. The doctor told me that Plavix and I are married for life. It seems that since I had my first heart attack in July 2003 and have taken Plavix all that time why after only 3 and 1/2 weeks would I develop clots?
Lance from Miami, Miami, Florida, USA, January 6, 2011

• Martin from Australia -- was your heart attack caused by a blood clot?? Or had your previous stents restenosed (blocked up with tissue growth, etc.)?? There's a big difference, even though both result in a blocked artery. The blood clot occurs quickly, often causing a heart attack. Restenosis occurs more gradually over time. A nuclear stress test (a.k.a. perfusion imaging) may show if the heart is not getting enough oxygen or blood flow. A CT scan may show if an artery is blocked, but sometimes is not able to image well inside of a stent (the metal in the stent causes artifacts on the image).
Angioplasty.Org Staff, Angioplasty.Org, July 14, 2010

• I'm 49 and pretty fit, non/smoking/non-drinker but with hereditary high cholesterol and family history of thrombosis. I just had a second heart attack after 'boot-camp fitness class. My right artery was 100% blocked and they inserted two DES stents in the same area they had placed one DES 4 years ago. My cardiologist has now put me on plavix for life to counteract blood clotting which seemed to have 'come from nowhere, no probs with Plavix and is covered under Austhealth care. My concerns are that stress tests etc are not picking up anything prior to both heart attacks and i have minimal symptoms beforehand with maybe some slight chest pain etc. Looking into CT scans as a better option for forewarning and interested to hear from others who have had multiple stents and perhaps I need bypass if there are any further problems. It is always the same right artery that is blocked. Also exploring link to lots of air travel bringing on problems? Cheers, martin
Martin Stapleton, Sydney, Australia, July 8, 2010

• Maria from Australia -- an angiogram (diagnostic only) will show if your husband has a significant blockage that is the cause of his problems. After that you can discuss with your cardiologist the options and whether a stent will help. Perhaps your cardiologist "suspects" a blockage and assumes he needs a stent, but that should be a decision you all make together. As for nothing getting cured, people on these Forums writing with only problems, etc. -- we've written about this before, but patients who post here seem to do so specifically because they have a problem. There are hundreds of thousands of patients who get stents and interventions who are fine and who get relief from angina or, in the case of emergency angioplasty during a heart attack, they have their heart muscle preserved.
Angioplasty.Org Staff, Angioplasty.Org, July 7, 2010

• Hello my husband has been tired the last 3 weeks, bit breathless. Cardiologist said probably has hereditary heart problem like his father. Booked him for an angioplasty in 3 days, we are scared by what we have read, Doc wants to give him a stent. Husband has bad oral hygiene for yrs, scared of dentist, I just read on the net inflammation triggers liver into making masses of cholesterol, in order to protect the body from bacteria in gums. Have you guys had bad teeth or gum problems preceding heart disease. I am feeling reluctant to support him in having the angioplasty done now, you all seem so frightened and nothing has been cured, nothing is better. What the hell are these Cardiologists doing to you all. I am in business and if I can't guarantee my work I shouldn't be in business, and if I done the wrong thing by someone I would need to rectify it, and be accountable for it. For 3 days now My husband has been taking a nutritional supplement called Proargi-9, invented by Dr. J. Joseph Prendergast, Nobel Prize winner from the High Desert Heart institute, in USA. If I lived in USA I would go there, this DR is committed to humanity, he reversed his own AVD.
Maria Seed, I'm a wife and mum,, Toodyay, Australia, July 2, 2010

• RN from California -- are you by chance taking a statin drug. These have known side-effects of muscle and joint pain for some. Haven't heard of this problem with Effient.
Angioplasty.Org Staff, Angioplasty.Org, June 15, 2010

• I had five Xience V stents in LAD & CX implanted in Sept 2009, then two weeks later they attempted to unblock the arteries in both legs, but was only successful with one, my dr prescribed Effient 10mg, I have had very bad pain in the legs and ankles since, mainly in the one that was unblocked, I had tried PT with no improvement, I went off my Effient for 4 days and did have some relief, but I am concerned about blood clots, how long am I going to have to take this medicine, I believe it is causing my problems with my legs.
RN, El Centro, California, USA, June 4, 2010

• Late stent thrombosis risk increased if stent crosses another artery? I have a huge 32 mm Taxus Express II in my proximal LAD that crosses another coronary artery. I am 4 years out now and doing very well on Plavix and aspirin. My cardiologist seems ambivalent about stopping DAPT - stop if I want or stay on it as long as no problems. I never see any data or even comments about if the risk is increased if the stent crosses another artery. It seems to me that the coating of the part "in the open" not against an artery wall would be more difficult?? What is known about this? I also know that thrombosis increase with stent length, and 32 mm is looong. I'm 62 and still have teens at home and want to do what I can. Thanks!
JW MD, Shelbyville, Indiana, USA, May 20, 2010

• I have 2 Bare Metal stents since Dec 30th 2009 went off Plavix after four weeks and stent plugged up they went in and opened it back up. Now doctor wants me on Plavix for 6 mos to a year but I have bare metal stents is this right? Having a hard time with this drug starting to itch and makes me feel awful most of the time. Doctor wants to put me on a new drug that is only a year old in the states it's Effient but may cause internal bleed more than Plavix. I'm also am a bleeder so I have to be very careful. And I'm very scared anyone have any suggestions?
Victoria, Chino, California, USA, April 27, 2010

• With the exception of finance, accidents and surgery associated problems, what, if any, are the long term issues associated long term use of Plavix, Low dose Aspirin and Warfarin? ie 10 years or more.
Tel, United Kingdom, March 28, 2009

• Alex -- your questions are the topic of much discussion in our other topics on "Plavix and Aspirin" and "Plavix and Surgery", listed in the right hand column. Guidelines call for Plavix to be used at least 6 months after DES implantation; many cardiologists are still concerned about very late stent thrombosis and so have continued Plavix in their patients for longer, assuming there are no complications from it. Aspirin is recommended for life, again unless there are complications. Surgeons usually request Plavix to be stopped a week or so before surgery, but these issues should be discussed with BOTH your surgeon and cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, March 23, 2009

• I am 46 years old. I had DES-stents placed in mid LAD and proximal first diagonal in January 2005. I started taking Aspirin/Plavix every day since then. My cardiologists always tells me to take it forever. Because of financial problem, about nine months ago I stopped plavix for 5 weeks and then restarted it again but taking it every other day. Now I want to stop it completely. What are the risks of stopping plavix (late thrombosis) given my history and the fact that I am taking it every other day? Does the risk end at any time or continues for life? If I stop it today, how many days later I could have a surgery. I already appreciate your help. Thanks.
Alex, Los Angeles, California, USA, March 19, 2009

• Hello, I am 56 and have 21 stents and had open heart, 5 grafts in 2002. Since 2002 I have had stent clots every 2 to 3 months with new stents placed each time or balloon angio. The most recent 3 days ago, I was in construction and was fit until I could do no exercise without pain and have since gained some weight. I am considering having another open heart to redo the grafts and start again, this could buy me some time. I have also had at least 7 heart attacks and my ejection fraction is 50%. Maybe someone has some advice since the Doctors have very little.
Ken, Missoula, Montana, USA, February 1, 2009

• Katie -- we're very sorry for your loss. The jelly-like substance sounds like it might be thrombus (a.k.a. blood clot) but the situation you describe sounds somewhat complex and it's hard to tell from your description exactly what occurred. Having two stents "collapse" simultaneously is uncommon, only because stents are pretty strong, once expanded fully. As for Plavix, normally antiplatelet or antithrombin drugs are given intravenously during a stent placement, specifically to avoid clotting. But these are complex medical issues and impossible to describe without specific knowledge. If you haven't, ask the interventional cardiologist to review the case, just to set your mind at ease as to what occurred.
Angioplasty.Org Staff, Angioplasty.Org, December 28, 2009

• Can anyone tell me if they have heard of anyone who went off the Plavix for a few weeks, went back on it for at least a month and then had a major heart attack during a heart catheterization? What was found was a "jello" like substance that was taken from one of the stents. Also, keep in mind that the patient had already undergone one heart cath a few days earlier in which two additional stents were put in and angioplasty was used for the drug coated stents. At that time, the two new stents collapsed and they had to go back in for another heart cath days later which is when the heart attack occurred. The patient died two days later after being placed on a ventilator and balloon pump. I need to know if anyone else has heard of this just to understand what happened to my Mom.
Katie, Dearborn, Michigan, USA, December 21, 2008

• Patrick -- This is a topic on stent thrombosis which is very different from your described problem. Total occlusions are one of the final challenges of angioplasty. There are ways of getting through them and negotiating the blockages, using ultrasound, magnetic guidance and retrograde entry (coming in from the opposite or even both directions). But a chronic, old, calcified total occlusion (i.e. "like cement") cannot be opened at present -- also because the occlusion is very old, your circulation has already developed collaterals to supplement the flow.
Angioplasty.Org Staff, Angioplasty.Org, December 6, 2008

• I had posted under another thread on this forum in February of 2007 regarding the total blockage in two stents that I have in the LAD artery. A reference was made in response regarding ongoing research on the topic of "chronic total occlusion". My cardiologist informed me that the blockage was "like concrete", and I have another stent in the RCA, as well as collateral arteries that have helped. Are there any updates regarding possible solutions to the total occlusion? Has anyone heard of a way to unblock DES that are completely blocked "like concrete", according to my Cardiologist? Thanks.
Patrick, Costa Mesa, California, USA, December 6, 2008

• Has there been any more conclusive research on the plavix rebound problems? I've had a medicated stent for 2 years and I'm still taking plavix. Is there any kind of weaning off protocols for safely discontinuing plavix? I will be discussing this with my cardiologist but wanted the benefit of any research you may have. Thanks.
Jack, New Hampshire, USA, November 25, 2008

• To Ben H. in Mass, Ben, if you are concerned, then invest your own time to learn! This fantastic website has a wealth of information, your topics were discussed numerously, all you need to do is read and learn, take charge of your own life. You wrote "heart stopped briefly". Although you did not say so, I assume that it was your own heart, so own it, damit, take charge of that ticker of yours. You listed drugs that others prescribed for you, but you did not list any other instructions. I suspect that your doc also instructed you to do some of the following - quit smoking, loose weight, exercise, reduce stress, yatta, yatta, yatta. The sooner, the better. Ben, we are in this together, this website facilitates it well, but it is a forum for sharing, not some free doctor thing. You made it last July, just as I made it couple years ago. Here are some optimistic words - cooperate, or even compete with your doc!!! How? When he prescribes Lipitor, take it as prescribed, but when he prescribes diet and exercise, beat his targets! It is something you can live with. Finally, IMHO, just in case the doc did not say so, make sure to take the Plavix and aspirin with food, not on empty stomach.
Tom, California, USA, November 25, 2008

• Hello fellow stent owners - I am 41 years old with 25 stents and I have advanced heart disease. I recently started a blog on the subject. You can read my story at I have linked to as I have found it to be one of the best sites on the internet concerning PCI. I hope my story will encourage others to hang in there.
Lumpy, Austin, Texas, USA, November 13, 2008

• For those who are worried about stent thrombosis, while using a DES stent, AND YET want the benefit of a lower restenosis rate, when using a DES as compared to a bare metal stent, you may want to consider using the latest DES that has just been approved in Europe, i.e. the Nobori DES by Terumo and the Bio-Matrix by Biosensors Intl. Both DES uses a bio-degradable polymer, and the manufacturers claimed that the DES will revert to a bare metal stent in 6-9 mths. However, if you do consider this, please seek your doctor for advice. Rgds Desmond
Desmond, Singapore, November 12, 2008

Ben -- We spent last week in Washington at the cardiology conference where the Danish study was presented. We will be posting an article soon about the Medtronic Endeavor safety issue, but the short story is there is no increased risk per se with this stent because the study only reported up to one year and very late stent thrombosis (what the FDA and everyone else has been concerned about) is defined as stent thrombosis that happens AFTER one year. With the CYPHER and TAXUS stents, there has been seen an increase in thrombosis of about 0.5-1% more per year -- but the Medtronic Endeavor has reported a significantly lower rate of very late stent thrombosis (VLST), about 1/6 of that -- and the data show it basically flattens out after a year, with no increase in VLST. The Endeavor does have a higher "Late Loss" (narrowing of the stent diameter) which hasn't translated to clinical differences in most other trials. The investigators, as well as many of the panel members, were surprised at the Danish study results, not so much that the Endeavor was less good than the CYPHER (the figures for the Endeavor were similar to what's been seen in other trials) but that the CYPHER results were so good -- uncharacteristically so.
Angioplasty.Org Staff, Angioplasty.Org, October 26, 2008

• If I may ask, has anyone here had experience with EuroCor's Taxcor stent system?
S., Massachusetts, USA, October 26, 2008

• Like so many of us, I have had a DES fitted what is now 18 months ago, and I continue to take Plavix and Aspirin. I just cannot understand how the medical profession, both stent manufacturers and cardiologists, have not come up with a definitive statement between them, about just what we are expected to do. I for one am not in a position, to make a judgement, and I think it irresponsible of them to say nothing.
tel, UK, October 25, 2008

• I had an MI on July 10 2008. Heart stopped briefly on cath table. An Endeavor DE stent was placed in LAD. On July 13, while still in the hospital, there was a repeat blockage, and a second catheterization took place. I have now finished a ten-week cardiac rehab course, and have had no symptoms of a possible repeat blockage. I am concerned about the conclusions of the Danish study of Endeavor vs. Cypher stents which was released last week. What is the best way to be aware of the latest developments and/or possible recommendations for modifying my present treatment (Plavix, aspirin, Lisinopril, Lipitor, Metoprolol)? Thank you.
Ben H., Massachusetts, USA, October 23, 2008

• It is Oct 2008 I am going for 2 LAD stents and not decided whether to get DES or not ? what is the general opinion now.
RG, Shelart, New York, USA, October 4, 2008

• Hello all, well I always thought that I was in great shape for a person nearing 50. Always ate well (too well!), non-smoker, regular exercise. I started having severe angina whilst climbing up one of the many cathedral towers in Barcelona. I did not think much of it because the pain just came and went. Months later, I was in Bali just sitting on the beach having a drink and had another attack which was much stronger and the pain lasted longer. My wife insisted I go get a check up. To cut a long story short, I eventually had a angioplasty then had 2 BM stents 1XCAD, 1XLAD done in Switzerland. About 2 months later had restenosis in 1 of my stents and had to get a DES. Now, 7 mths later am told that the artery I had the DES is still blocked and that I have to consider a bypass graft. Does this ring a bell with anyone? I am from Singapore and live in Switzerland and do not understand swiss german very well so, I consider myself to blame for not taking the time to understand what is being done to me and just trusting the doctors advise. Plus, I am a cinematographer and am always on assignment in different countries so, I did run out of Plavix in Bali for about 14 days.Some of you guys must think I have a death wish. I have since kept myself well informed and would like to hear from anyone with the same symptoms and who had to have a bypass graft after getting stents. Thank you and stay well.
Steve L., Switzerland, August 9, 2008

• My husband just had a stent put in and is taking plavix. The docs did not explain the risks of coming off plavix or how long he would be on it, or that if he misses a few doses he could have a heart attack. That is so that they can get more people convinced that it's a great drug before they know whether it is great or not. The docs get free materials, food, trips from the drug companies and they also are into helping patients. And to do this they need patients that they can include with their research. That is why we all get partial or incomplete info by docs who want to try this stuff. Now is my husband stuck on plavix forever or what? No one explained any part of what I read in this site.
Marilyn S., Massachusetts, USA, June 27, 2008

• Walt -- thanks for writing in. July 2007 was just prior to when the issue of increased tendency of late stent thrombosis in drug-eluting stents (DES) surfaced. We've seen DES usage drop from 90% to the low 60's. Again, the occurrence rate is very small (but try telling that to a man who fell into a snow bank and almost died). There may have been very good reasons for placing DES in your arteries -- remember that bare metal stents definitely have a higher risk of restenosis. But your point is an important one -- that patients should be fully informed about the implications of each type of device, so they can make an educated choice.

There is definitely a cause for concern about the increased risk of late stent thrombosis with DES, especially when paired with a recent study stating that Plavix may have a rebound effect, causing a doubling of the risk of thrombosis and heart attack with the 90 days after stopping. As you point out, patients who have had a stent thrombosis are more likely to get one again -- that's because some people are more likely to form clots due to genetics, lifestyle, lipid profile, etc. And that may be why stopping Plavix for even as little as two days had such a negative impact. Obviously you are someone who should be on Plavix long-term, assuming there are no bleeding or other complications. What does your cardiologist say?
Angioplasty.Org Staff, Angioplasty.Org, April 28, 2008

• My name is Walt and I had a major cardiac event July 7, 2007 and they found two blockages, 90% and 70% in the same artery. On 07/09/2007, they implanted two TAXUS drug eluting stents with absolutely no explanation to the difference between BMS and DES, nor any information about that I would have to be on Plavix with Aspirin the rest of my life. I am on three other meds also. I also had a pace maker/defibrillator put in the next day. On Jan. 6th, 2008 I had a stent thrombosis with absolutely no warning. I fell into a snow bank next to where I was washing my car to die, but the defibrillator shocked me three times to get my heart started again. (The Dr. showed me the read out from defibrillator of the event.) (One week prior to the stent thrombosis I was out of Plavix over the weekend -- 2 days -- huge mistake.) Went back to hospital to find 95% and 70% blockage at both TAXUS stents in just 6 months. Stent thrombosis in most cases is fatal where restenosis is more gradual in forming. It looks to me like the drug companies win in both cases, triple cost of stents, (about $2,500 each) and the addiction to Plavix for life (about %1500 per year) or die. If I would have known then what I have research now, I would have never let them implant drug eluting stents the first time. They replaced the stent blockage at the TAXUS stents, with the BMS half in the TAXUS stent and half in the vain. I now find out that if you have had a stent thrombosis, you have a 1 in 6 chance of having another. Not look forward to another shocking experience. By the way one week later, Jan. 13, 2008 while watching TV, my defibrillator shocked me four times for no reason at all. My heart was working just fine. What are my options, I am 66 years old, never smoked, 200 lb. six foot and thought I was in great health.
Walt Beermann, Primerica Financial Services, Denver, Colorado, USA, April 17, 2008

• This research would certainly explain my experience. Had a Taxus DES fitted to my Circumflex artery in December 2005 after silent MI. Only 45 at the time. On Plavix for 12 months. 73 days after stopping Plavix had a heart attack whilst driving my car circa 70mph. Fortunately was passing a hospital at that moment in time, parked the car by the Emergency entrance, walked in and was treated immediately (by clot busting drugs). Pain to treatment was 27 minutes so got away with no damage to my heart. Angioplasty 36 hours later could find nothing wrong with me or any sign where the thrombosis had occurred, but good condition of arteries suggested a Late Stent Thrombosis. Have been on Plavix since. I don't smoke, am pretty fit and lead a relatively healthy lifestyle. Will be interesting to see whether further research will provide evidence to support this illuminating research.
David, England, February 8, 2008

• The Study -- I have had two stents placed some 10 months ago, am taking Plavix. This new study gives us the raw figures but analysis of what those numbers mean may take some time. I don t believe one can yet point the finger at Plavix, (Clopidogrel) For any drug that protects against clotting, one would expect the number of thrombosis events in patients to increase significantly when it is discontinued. The very reason for taking the drug is because patients have conditions which put them at risk to the formation of a clot. In other words, had they not been on Plavix, many patients would have thromboses over a period of time, which were prevented by the drug. Plavix protects against thrombosis but does not fix the underlying condition, so if those conditions persist, when the drug is discontinued the events finally occur, crammed up like a concertina in the months following. I would agree that if you have taken the drug following stent implantation, it would be wise to have a final thorough checkup and consultation as advised by our forum editor before discontinuing. Maybe someone can advise as to how this may be best accomplished.
Keijo Musto, Jamberoo NSW, Australia, February 7, 2008

To All Patients On Plavix: take note of a very important new study published in today's Journal of the American Medical Association. The finding are basically that there may be a "rebound effect" when you stop taking Plavix -- so for a period of around 3 months immediately after you stop, the risk of your blood clotting and having heart attack, is DOUBLE what it is later on. And this effect was seen no matter how long the patients were on Plavix: 3 months, 6 months, a year and more. And the authors studied over 3,000 patients.

This does NOT mean you should not take Plavix. The benefits of the drug, especially for stent patients, are well-documented. It means that there needs to be more research as to what this effect is and possible strategies for going off Plavix -- for example, slowly reducing the dose, or increasing aspirin during this period, etc. The advice to patients that the co-author of the study gave to us at Angioplasty.Org is that if a patient has finished their prescribed dose of Plavix, they should discuss with their cardiologists whether they should continue or not, especially in light of this study.

Of interest to us also is the fact that a higher risk of blood clot mean that possibly that at least some of what has been seen as "stent thrombosis" might be related to this rebound effect of Plavix, and is not a problem with the stent at all.
Angioplasty.Org Staff, Angioplasty.Org, February 6, 2008

• D/Sir.Dr Ashok Seth of MAX Heart and Vascular Research at SAKET N DELHI did Angioplasty and he told me after the check angio that it is thrombosis and not restonosis.Why it was not removed.. is because i have some Ulcer at the small intestine which cause me to become anemic and right now it is under treatment of a Gastroenterologist Mr Vivek Raj also from Max. after 2-2.5 months. Dr. Seth has asked me to come again and then my Angiography and stent removal will take place. What I am really worried is that what is the reason for thrombosis and what steps are required for its prevention.
Dr Bishwaranjan kumar, Bihar Govt, Bihar, India, February 4, 2008

• Dr. Kumar -- are you sure your cardiologist called it "thrombosis"? Stent thrombosis is defined as a blockage caused by blood clotting (the causes of which are several) -- but blood clotting happens pretty dramatically and needs to be opened immediately (a clot tends to block the entire diameter of the stent/artery, usually causing a heart attack). How did the thrombosis clear? Perhaps he/she meant "restenosis", which is the growth of tissue -- something which usually takes a bit of time to occur, and can be partial, causing anginal pain, but not an infarction (heart attack). We assume you are remaining on aspirin and clopidogrel (Plavix).
Angioplasty.Org Staff, Angioplasty.Org, February 2, 2008

• I am 51 yrs old with absolutely no history of smoking/drinking/obesity/BP etc. I maintained 70 kgs wt for last 5 yrs though I was chronically Anemic due to gastric ulcers.On december 14 2007,I had a severe pain during sleeping and after which I underwent angioplasty and 2 DES where put.One on the LAD (100% block) and one on the right minor artery of the heart. After 25 days,on the 21st of january 08 during the period which i took all precautions about drugs (clopidogrel, aspirin and all such drugs etc)and food, i was experienced same anginal pain during normal activity and saw my cardiologist who said it is very rare but your LAD (bigger) one stent has been reblocked due to thrombosis. While he could not explain why?and whether it will repeat ..i am really worried about my help me ..i am really worried..What steps/tests should i take more?what will happen to me? will i die early ?man i have lot of responsibilities to handle as I am only 51 yrs old with 2 kids and a old father.
Dr Bishwaranjan kumar, Bihar Govt, Bihar, India, January 31, 2008

• EM from Greece -- it's really hard to say why you had these heart attacks just months after stopping Plavix, but stayed tuned to this site -- we're going to be covering this and other issues with Plavix and stents in the very near future.
Angioplasty.Org Staff, Angioplasty.Org, January 31, 2008

• Well I haven't got the strength to read all posts here but I would like to state my experience in a few words. I had a heart attack at the age of 23. No explanation was given (apart from smoking) but I had a DES inserted. A year later I was told to stop taking Plavix. Two months after that I had a second, nearly deadly attack. Back on Plavix for a year and again two months after stopping taking it a third attack. Luckily I was 10 minutes away from the hospital. I was on the spot treated with PTCA and the doctors saw that the stent was fully 100% clotted. Thank god the doctor after frustrating tries managed to save me and placed a second DES on top of the first. Now 2.5 years have past with no problems and Plavix along with aspirin is more important than food and water. But the psychological effects from all that...far beyond description. No one ever explained to me what was going on and I came to find the truth months after the third attack on 09/2005. People ask persistently more than one doctors for information. DES help thousands of people but that 0.6% or 3% or whatever "small" number of people (0.6% x 3000000 des/year=18000 people) is risking their lives. I just got lucky...
EM., Athens, Greece, January 23, 2008

• R. from Wisconsin -- call the interventional cardiologist who did the stenting and report your symptoms. There may be other things at work here. Stent thrombosis (or blood cltting in the stent) is a pretty acute event, that is, it happens quickly, and is pretty dramatic. But don't hesitate to call your cardiologist. That's why he/she is there.
Angioplasty.Org Staff, Angioplasty.Org, January 20, 2008

• I developed restenosis and was restented on Dec.31, 2007. This time with Cordis stents. Since that time I have had increased shortness of breath and the pressure in my back has increased, although it is not painful enough to go to the ER, yet. what should I be looking out for and when is it an Emergency? I take the big 4 meds for stents and am on time and never miss. I am getting more anxious every day.
R., Hartland,Wisconsin, USA, January 11, 2008

• MikeS -- we hear you. The area of aspirin or clopidogrel resistance in patients is as yet relatively new. There are tests out there (some made by San Diego-based Accumetrics), but an article in the Journal of the American College of Cardiology last November, titled "Platelet Function Monitoring in Patients With Coronary Artery Disease" observed that the current tests are far from perfect and that this field urgently needs better research.
Angioplasty.Org Staff, Angioplasty.Org, December 20, 2008

• Playing catch up since Feb. 2006 post. July 4th LST (clot in stent) thrombosis in RCA Full metal Jacket I spoke of. i ask that no stents be placed before lat 2 of six they put 2 in lAD anyway . As I predicted (again) November 2007 LAD stent Thrombosis in stent while on Plavix and aspirin. Each time (3) I suggested an MI was soon following my chest pain and even told docs where to find the clot. Seems pretty predictable that the next will be in the last stent placed in RCA . I can set my clock about 4 months after i tell them and within 11 months of placement. I was told they would bypass prior to a post op cath that apparently cleaned me up as i felt better immediately and for almost 9 months after. It seems that if they did cathed/or angioplasty every six months that it may have unclotted at least buying me a few more months before a total clot. This sounds strange but i bet that left untreated i can again predict another in 12 months or less. Simply stated I feel it long before they see and believe it and this last clot cost me a third of my heart muscle . I can't afford for them to keep foot dragging while I suffer months before. I will not allow anyone to stent me again and need an expert dedicated to the truth regardless of the politics. I am neither an Idiot Savant nor Idiot and tired of the Pharmafantasies docs rely so heavy on . Aren't there markers that can predict clots. MI/s or a 64 slice imaging option. I asked 3 docs over a year ago to test me for plavix and aspirin resistance. None had heard of it then and even to date after asking again none have referred me to a lab/office or modality that does this .Any new predictors that can compete with my our suffering especially ones that these lazy docs can actually believe when they refuse to listen to the patient, I have fired the stent profiteers and several docs attempting to restent me. I am concerned that doubling the plavix will actually harm me as well as many other meds they now suggest. Again thanks for supporting those trying to help us. (Note: This post has been edited for length and content).
MikeS, Stent clotter, Florida, December 16, 2007

• F. in Lebanon -- millions of patients have had drug-eluting stents put in. Stent thrombosis (clotting) only happens very rarely. It is important to keep taking your meds, especially Plavix and aspicot (a form of aspirin) so your risk is reduced. Recent studies have shown no greater risk in drug-eluting stents than in the older bare metal types -- and stents have been helpful to many patients in relieving pain. Stents also provide pretty much the same help as open heart surgery, in the right patients. Are you having any adverse symptoms? By the way, stents cannot be "taken out" because they become part of the artery wall.
Angioplasty.Org Staff, Angioplasty.Org, November 30, 2007

• I put 2 cypher stents in 4/9/07. Taking plavix+crestor+aspicot 100mg+metformine 850mg+omega3&6. When reading what people say I have been afraid from the future. Can I take off the 2 stent by surgery& find another way for my artery. Thanks.
F., Lebanon, November 30, 2007

• Bob -- for more information on the Endeavor, as well as the upcoming Abbott DES, and their purported advantages, read our feature, "FDA to Review Abbott's XIENCE™ V Drug-Eluting Stent".
Angioplasty.Org Staff, Angioplasty.Org, November 7, 2008

• Looks like Medtronic and its Endeavor is no better than other current DES's. How can the FDA let a product that is at best equal to, but appears to be worse than, the current products available go to market. Would really like to see some feedback from Physicians defending this product.
Bob Puckett, Snellville, Georgia, USA, October 24, 2007

• Martin -- a deeper understanding of this problem is what everything is looking for. For example, most cardiologists prescribe Plavix and aspirin now for 1-2 years or life. But a study out of Milan showed no statistical benefit past 6 months. However, when asked how long they currently prescribe the dual antiplatelet drug, Dr. Cieffo, who ran the study, said 1 year, at least. Some believe that the cause of stent thrombosis is incomplete healing, where the endothelial cells are not able to cover the metallic surface, which is thrombogenic. Others feel it is mal-apposition, where the stent was underdeployed from the start. Dr. Antonio Colombo of Milan discusses this in his interview with us about Intravascular Ultrasound (IVUS). others feel it is a specific small subset of patients who have some type of tendency for thrombosis, as yet unidentified. Go to our Drug Eluting Stent Center for links to various articles on this site that may help you.
Angioplasty.Org Staff, Angioplasty.Org, August 7, 2007

• hello together, what i need is a deeper understanding of the mechanisms that lead to stent thrombosis. Why does the agglomeration of platelets take place? can you give me some answers or references where i can find information regarding my topic? thanks in advance...martin
Martin, Hannover, GERMANY, August 5, 2007

• The reason for my posting is I have noticed that in the past 3 months issues with DES have almost gone away. There has been nothing on the internet. I have not seen any response to Rep. Waxman's request for information from BS and J&J. Maybe its just our goverment is that slow, I don't know, but they wanted the info in two weeks, that was over 4 months ago.
BobPuckett, Snellville, Georgia, USA, July 30, 2007

• WOW, Sounds like Medtronic may have got it right. These articles about their new DES really come in at the right time. Hope they are successful in getting on with business and getting FDA approval. I have been real skeptical about having another DES implanted, but this is really exciting and hope they are not holding back any information. If there trials are legit, and I think they are, BS and J&J can hang it up in areas they compete. It's nice to know there is a better way, not just BS and J&J's way.
Bob Puckett, Snellville, Georgia, USA, June 2, 2007

• Kim -- great story demonstrating that non-cardiac docs are beginning to get the message about Plavix and drug-eluting stents and are changing their procedures accordingly. Really a must-read for all. We are cross-posting your reply to the Plavix and Surgery topic as well.
Angioplasty.Org Staff, Angioplasty.Org, May 24, 2007

• Thank you for responding to my post! His Cardiologist insisted that he not go off his medication for any amount of time until he hits the 12 months then only for 5-7 days. I consulted with his doctors at Johns Hopkins and UCI. They both agreed to perform an endoscopy under twilight conditions while on his medication. Dr. Canto at John Hopkins wrote me the following: Doing mucosal biopsy on ASA and possibly plavix is not a problem. It is only if we dilate or do EMR that there would be a risk of bleeding. The American Society of Gastrointestinal Endoscopy has recommended that ASA and NSAIDs do not need to be stopped. We are getting his checkups at UCI, so we don't have to travel to Baltimore every 3 months. The plan was to only take biopsies if they saw something that looked questionable. And if then, only 1-3 rather than 8-15 like they usually do. Everything went well and his esophagus looks clean. Therefore, no biopsies and probably no cancer! But I have to say this puts us in a precarious position. Looking back now, I know why the Cardiologist looked alarmed when I told him about his cancer treatments, the first time I met him in the operating room after the surgery. He told me he did not know about it. It should have been in his chart. It was the ER but we had been in there only a couple of months before because he could not swallow, results of the PDT (cancer treatment) scaring - somewhere things did not get communicated. The Cardiologist is one of the best doctors around, I am told. But knowing that EMR or dilations are a problem is worrisome as my husband has had EMR and PDT for his cancer in August 06 and as had 9 dilations from December 06 to March 07. Now we just have to wait and PRAY for the next 10 months that he stays cancer free and he doesn't need to be dilated!
Kim, California, USA, May 24, 2007

• Kim -- Back in January, the six major professional organizations, dealing with cardiology, surgery and even dentistry, issued a joint "Science Advisory" regarding the concerns over premature discontinuation of antiplatelet therapy. Recommendation #2 was:

"In patients who are undergoing preparation for percutaneous coronary intervention and are likely to require invasive or surgical procedures within the next 12 months, consideration should be given to implantation of a bare-metal stent or performance of balloon angioplasty with provisional stent implantation instead of the routine use of a DES."

This Advisory was widely reprinted and featured in Circulation, the official journal of the American Heart Association, and elsewhere. And the recommendations were not particularly new -- these ideas had been circulating for some time (see our own "Patient Advisory" which we posted four months earlier). You can read more about the "Joint Science Advisory" in our January 29, 2007 article, titled appropriately: "New Advisory: Will Stent Patients and Their Doctors Get the Message?". Unfortunately, in your husband's case, it seems that the interventional cardiologist had not gotten the message.

So what can you do? Read our news piece and the advisory, which is linked to. Print it out and bring to your husband's oncologist. Some surgeons and dentists have been performing certain procedures, even with the patient on Plavix -- or making some sort of adjustment, very temporarily. As the Advisory states, have the cardiologist and surgeon talk to each other. Just because it's standard practice to have patients go off Plavix and aspirin prior to a surgical procedure (even a biopsy), doesn't mean it can't be done -- certain measures can perhaps be taken to control the bleeding -- this, of course, varies from doctor to doctor and procedure to procedure. But not keeping tabs on a potentially deadly cancer does not seem right. Let us know what you find out..
Angioplasty.Org Staff, Angioplasty.Org, May 15, 2007

• Has anyone ever known anyone that had a Drug eluting stent put in even though they were going through other treatments for cancer? The cardiologist at the ER put a stent in my husband because of chest pains. But did not read his chart about his history of esophageal cancer. He had cancer treatments at Johns Hopkins 6 months earlier and his last test was cancer free. But he is on a strict every 3 month biopsy check, as esophageal cancer is known to return. Now, he is very limited in getting these checks and if the cancer does return in the next 10 months we can't do anything about it. This cancer is very deadly and can not be left untreated. Aren't the doctors required to screen a patient before they place these type of stents? Wouldn't a bare stent been the answer for him? I would like to know if anyone has any information regarding this. Thank you, Kim
Kim, California, USA, May 14, 2007

• Angioplasty.Org has written two articles regarding the ACC reports of the COURAGE trial, which is not really about drug-eluting stents at all. But they do deal with the question of stents vs. drug therapy and can be found here: "Don't Cancel Your Angioplasty or Heart Stent Yet, Say Patient Advocates" and "Answers to Top Ten Questions About Stents and Angioplasty vs. Drug Therapy".
Angioplasty.Org Staff, Angioplasty.Org, April 12, 2007

• What is your take on the meeting of the ACC 07 summit held in New Orleans this past weekend? Sounds like a lot of physicians still are uncertain exactly what to do. Not that they can't take the safe route, but are unsure exactly what the consequences are of using DES's in the long term. I keep seeing that everyone is saying to take plavix and aspirin for 12 months, I've been on them 24 months and my doctor will not even discuss me coming off of them. By the way I have moved and my address is different than previously posted.
Bob P., Snellville, Georgia, USA, March 28, 2007

• Regarding what is off label and on label use of drug-eluting stents, here is the FDA statement of indications (i.e. "on label use"):

  • The CYPHER Sirolimus-eluting Coronary Stent is indicated for improving coronary luminal diameter in patients with symptomatic ischemic disease due to discrete de novo lesions of length ≤30 mm in native coronary arteries with reference vessel diameter of ≥2.5 mm to ≤3.5 mm.
  • The TAXUS Express Paclitaxel-Eluting Coronary Stent System is indicated for improving luminal diameter for the treatment of de novo lesions ≤28 mm in length in native coronary arteries ≥2.5 to ≤3.75 mm in diameter.

By de novo, the FDA means lesions not previously treated. Any other use is technically off-label.
Angioplasty.Org Staff, Angioplasty.Org, March 17, 2007

• Thanks. I don't know why I kinda got mixed up. My DES's were actually 3.5mm in Diameter. You're right -- one was 8mm long, the other was 24mm long. I had these implants after a heart attack. Is that considered "off-label"? Thanks, Bob
Bob P., Georgia, USA, March 15, 2007

• Bob -- stents have two measurements: diameter (or width) and length. A large coronary artery is around 4mm. When you refer to 8mm, you are talking about the stent length -- and 8mm is the shortest length stent made. When your cardiologist is discussing using BMS in "small" vessels, we'll bet he/she means "short length blockages"; likewise when the cardiologist says "large" vessels, he's probably referring to "long" vessels. Long vessels (i.e. long blockages) are more prone to restenosis, thus DES is preferred.
Angioplasty.Org Staff, Angioplasty.Org, March 14, 2007

• Well, had my visit to the cardiologist Friday. Brought up the DES controversy and he really didn't want to talk about it too much. But one thing he did say was that they plan on using bare metal in the smaller vessels and DES in the larger ones. That tells me they have a totally different way of thinking than they did when I had my DES implanted 30 Dec., 2004. You see, the Diameter of my stents were 8mm. Seems small too me. Any comments?
Bob P, Lawrenceville, Georgia, USA, March 6, 2007

• Wish all this information was available 20 months ago, maybe I wouldn't be one of the people with Stent Thrombosis who almost died. May 4, 2005 at 3:00am I had severe heart and chest pains. My son called 911 and I didn't think I was going to make it to the hospital. The results, blood clot in my DES. I am now totally disabled and cannot do much of anything. Have had defibrillator implanted and struggle every day to survive, both physically and financially. You see, Social Security doesn't understand or care. That makes it all the worst. I had been unemployed 30 days before the thrombosis. Only the second time in over 40 years. Luck of the draw I guess. I want people to understand what can happen. My doctors have been great taking care of me and making sure I had the medicine I needed, however they have never discussed the DES or ST with me. Guess they have their reasons, I will however mention it next week when I see both of my Cardiologists. By the way, I was implanted with 2 each TAXUS Express 2 stents on December 30, 2004, the day after a myocardial infraction. Maybe if I had the information we have today, it wouldn't have happened. I know I was on Plavix after the implants, I am just not sure if I had quit taking them. It is possible that I quit, as my financial situation was going down hill fast. I will need to check back with the pharmacy to see. I have not quit taking it since the clot and I do take aspirin everyday. Also my ejection fraction is +-25%. One other thing, I had a bare metal implant in July of 2002 after a heart attack, no problems.
Bob P., Georgia, USA, February 21, 2007

• Mike -- thanks for the clarification. And your questions are good ones. As for the dosage of Plavix, current recommendations are 75mg daily -- the antiplatelet action related to your blood, so dosage isn't increased for a greater number of stents. Also one has to be careful to watch for bleeding problems. We assume you are doing what you can to reduce risk factors, like proper diet, exercise, no smoking and staying on prescribed meds. As for bypass, this is a question for your cardiologist. There is thought that certain more complex cases may do better with surgery -- and the "full metal jacket" you speak of won't "weigh you down" but it can complicate the ability to do a bypass. But there may be very good reasons why bypass surgery was not recommended for you originally -- and reblockage is something that occurs with surgery as well -- many surgical patients end up having a reblocked vein graft opened with angioplasty and stents. But these types of decisions are complex and the answers very specific to each patient. They would best be answered by a cardiac surgeon AND an interventional cardiologist who have your records and angiograms in front of them. In some institutions, these specialties wind up competing with each other (the surgeon believes that bypass is the best, the cardiologist always votes for stenting) but more and more, these specialities are working together, hopefully, to provide the best treatment pathway for the patient. Let us know what you find out and keep in touch.
Angioplasty.Org Staff, Angioplasty.Org, February 20, 2007

• Editor, As you mentioned I do know the Physical Difference as well as having been told prior it (chest pain ,vomiting, shortness of breath then VTach) was all in my head. Without a doubt my 100 percent clot (SAT) within the second stent caused a heart attack and brief stint with death, coding and multiple dif included I wasn't however, familiar with the visual /diagnostics in a docs determination or visual observation of thrombosis. The 1st stent was restenosis in a DES, The second behind it was to fix the problem. The second however Clotted 11 months later and two more placed after the THROMBOSIS in the aforementioned second stent. Thanks for explaining the visual differences. How much plavix does six stents require? How long? And at this point how many stents before one should have a bypass being that stenting in this case seems to raise the risks of even more clotting especially when 4 of 6 are in the same artery (two which have failed already) Again the 1st was restenosis the second was clearly Thrombosis. Does watchful waiting run the greater risk and chance of another SAT and even death? Won't The full metal jacket eventually weight you down? It seems that previous clotting within stent 2 might indicate that stent numbers 3 and 4 in same vessel share increased risks of Thrombosis given the combined effects of other DES's within the same vessel. My questions here are simple, why not bypass now before another clot kills me? Why wait? And why let anyone stent again?
Mike S, Florida, USA, February 12, 2007

• A belated reply to Bill in Maine -- you are correct. The figure for increased risk of late stent thrombosis in drug-eluting stents over bare metal stents is usually quoted at 1 in 200. This is overall. However, it all depends on what study you look at. There are many -- and their results are different. Many were presented at the FDA Panel stent safety meeting in December and there is no agreement -- a group has redefined what should be categorized as stent thrombosis, so that's changed things. One thing seems clear. There is a slightly elevated risk of this in drug-eluting stents. It may be that the risk only exists for certain patient populations. What patients need to do is stay on their prescribed antiplatelet therapy and make sure to read our "Patient Advisory"
Angioplasty.Org Staff, Angioplasty.Org, February 10, 2007

• Mike -- As the patient in whom this occurred, you would definitely know the difference between restenosis and thrombosis. Stent thrombosis occurs in a very immediate and usually sudden way. The platelets start to clot and very quickly you get intense chest pain, as in an acute heart attack. The blood clot needs to be opened immediately or the heart muscle will infarct and die -- this is why stent thrombosis is fatal 30-40% of the time. Late stent thrombosis is a cause of concern in drug-eluting stents, which is why staying on Plavix (or Ticlid) and aspirin for a year or more is so important.

Restenosis is something that occurs over time, as the scar tissue builds up inside the stent, something that occurs less in drug-eluting stents than in bare metal ones. Ultimately, the stent may become blocked, but often, the patient may feel the return of angina in his/her heart -- a stress test may be done, followed by an angiogram, and then usually a second stent is inserted inside the old blocked one. This is one of those technically off-label uses, but most studies have shown putting a DES inside of a previously restenosed stent to have the best outcomes. Occasionally, the patient may not sense the stent blocking up, and it may progress to a heart attack or acute coronary syndrome. According to a recent Cleveland Clinic study, this occurs about 30% of the time when there's restenosis. But the death rate is nowhere near that of thrombosis. By the way, your confusion is shared by many. Even Dr. Fogoros, the heart expert at About.Com, constantly refers to late stent thrombosis as "late restenosis". It's not. It's a totally different biological process. As for proof, if it's thrombosis, there's usually a large fuzzy grey blob on the angiogram completely occluding the artery -- restenosis is darker, denser, more discrete. Our guess, from your description, is that you had in-stent restenosis. Was the stent that restenosed a bare metal stent? Did they put in a drug-eluting stent to fix it?
Angioplasty.Org Staff, Angioplasty.Org, February 10, 2007

• I have recently had in-stent thrombosis (11 months later) this stent was placed behind one that was then called Restenosed? How exactly does one tell the difference? How can a person be sure that even when told it's stenosis it's not thrombosis. Given the money and politics here, how can we tell who's telling us the truth? It seems that some docs would rather call a clogged artery or occluded artery than get into the Clotting Ring Of Fire especially after the patient complains early of symptoms. [Post edited for length]
Mike S., Florida, USA, February 6, 2007

• John -- thank YOU for providing the information which can be communicated on this Forum. We welcome other patients to share these types of stories. We're also posting this on the topic concerning Plavix and Surgery.
Angioplasty.Org Staff, Angioplasty.Org, February 6, 2007

• I just wanted to share my experience. I had a DES implanted in October and I'm on Plavix, Lipitor etc. Last weekend, I broke a back molar and it needed to be pulled. I was concerned with bleeding complications due to the Plavix. The oral surgeon said as long as I was not on Coumadin, he felt comfortable pulling the tooth. So he pulled the tooth. For about 2 hours, I squeezed gauze on the spot where the tooth was pulled and it stopped bleeding. Aside from some swelling from pulling the tooth, all seems to be ok. Hope this information is helpful. Thank you for providing this forum to communicate.
John, New Hampshire, USA, February 5, 2007

• Lynn -- a recent study has shown that, even though this technique is strictly speaking "off label" in the U.S., the use of a drug-eluting stent to re-open a reblocked stent is probably the best therapy. As for going off Plavix and aspirin for dental work, read our latest article about the joint "Science Advisory" -- the American Dental Association had advised its members of the dangers of taking patients off antiplatelet therapy and advises that much routine dental work can be done safely without taking patients off their meds. It just seems that many dentists have not gotten the message. Feel free, as patients, to educate your dentists. Lynn, in your case, if you are back on antiplatelet therapy, you should be fine. But if you are feeling anything uncommon, by all means, report this to your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, February 3, 2007

• I just have one question-If you have a DES that has already been restented because of restenosis-now 2 DES in one artery-are the chances higher it will happen again? I just had a stress test in Nov.2006 after the 2nd stent and everything was clear. But since then I have had dental work and was off Plavix/aspirin 5 days. You replied to an earlier post from me about that but my concern is a slight squeezing in my chest. That is how I felt before the 2nd stent was inserted which also was after dental work July 2006. Thanks. you have been more helpful than anyone!
Lynn, USC, Columbia, South Carolina, USA, February 2, 2007

• On Feb.1 B. Parvizi you mention having by-pass surgery after apparent late stent thrombosis in a DES. You indicate that you hope this reduces the possibility of further late in-stent thrombosis. I intend to discuss the possibility of by-pass surgery with my cardiologist on my next visit, even though I haven't had an in-stent thrombosis. My DES Stents were "off-label" and in complicated areas so I believe my chances of in-stent thrombosis are unfortunately higher than average. However, I would think that the bypass surgery would not lessen the chance of in-stent thrombosis, but hopefully would lessen the chance of an MI or SCA from the thrombosis, since blood-flow would continue around the clot via the bypass. Is my logic correct? A problem those of us in the U.S. might face who might request bypass surgery before experiencing an in-stent thrombosis is that health insurance carriers might refuse to pay for the bypass, since the stent is still functional.
Thomas T., Arizona, USA, February 2, 2007

I am now at home recovering from my by-pass surgery. I only hope that the by-pass of these two DES has now reduced the possibility of further late in stent thrombosis . Clearly I am very disappointed that the manufacturers of the DES are not taking such cases more seriously and identify the patients at risk. To go through implanting two DES 2.5 years ago and then a heart attack followed by SCA, to find out that some DES are prone to late stent thrombosis and be forced to have a by-pass is just not good enough .The manufacturers have duty of care to keep the public informed of such defects which could have cost me my life.
Mr. Bahman Parvizi Ph.D., London, United Kingdom, February 1, 2007

To Rick, New York, USA, January 1, 2007 I can only speak for myself, but I have had 24/7 AF for over 8 years and so was already on Warfarin (Coumadin) at around 5mg to keep INR at between 2-3. So when I had my first stent a year ago I was bit concerned, with the extra addition of Aspirin 75mg + Plavix 75mg per day. I never had any real adverse effects (although i did cut myself once and it was a sod to stop, but it did). So when I had my second stent fitted in Dec 2006 I was still on all the above, but my cardios` own regime is to insist on 325mg Aspirin for 6 weeks post op, then continue at 75 mg + all the others. So far so good, so it is possible.
tm from UK, January 11, 2007

• There's no test for thrombosis, but there are certain clinical indications for a higher-than-normal chance of both restenosis and thrombosis -- very long lesions, very eccentric (or craggy) lesions, narrow arteries, diabetes, etc. But as for late stent thrombosis, it is hard to determine who might be more at risk.

As for a hypersensitivity reaction, certainly anyone with a known allergy to stainless steel or its components (e.g. nickel) should not get any type of stent, bare metal or DES. Anyone with a known allergy to the drug on the stent should not get that stent. As for the more undefined (as yet) allergic reactions to the DES polymers, a cardiology group we are working with is doing a study, in part to develop a test for this type of hypersensitivity. It's the only group we know of investigating this phenomenon.
Angioplasty.Org Staff, Angioplasty.Org, January 10, 2007

• I'd like to ask if there are any tests or procedures that could be performed on a patient before having a stent placed in their heart to predict the chances of the occurrence of thrombosis or a reaction to the drug-eluting device?
G. Ulmer, Ohio, USA, January 10, 2007

• Dr. Parvizi -- certainly sounds like late stent thrombosis. Cause of this is not really well-known, although Dr. Renu Virmani, a pathologist in the Washington area, has done pioneering work in determining that DES can cause delayed healing. In some individuals, some of the metal struts in these DES stents don't get covered by a layer of endothelial cells, and therefore are more thrombogenic, or prone to clot formation. Why this happens in some individuals (relatively few) and not in others is not known, but may have something genetic involved. Best wishes for a successful outcome in your surgery and thank you again for sharing your story with our readers. Let us know how thing go.
Angioplasty.Org Staff, Angioplasty.Org, January 7, 2007

• Both the cardiologists at the A&E and my own cardiologist after seeing the CD of my angiogram confirmed that although there were some sign of scaring with in the stent it was not enough to cause the MI and in stent blood clot must have taken place and it was removed via the use of heparin in the A&E. It is for this reason that my cardiologist is concerned that the in stent blood clot could happen again and next time I may not be near a ''National Grid''. I am off to the hospital this afternoon to bypass the stents tomorrow morning,( you are correct stents can not be removed. It was my wishful thinking not my cardiologists.) When I am out next week or so?!! if you are interested I will be able to forward you copy of the CD.
Bahman Parvizi Ph.D, London United Kingdom, January 7, 2007

• Report of seeing Cardio: Told Cardio of pain experience. He suggested I try Nicorandil as an alternative to Nitro patches, and has scheduled a Stress Test for Feb. Stents fitted were as follows: Original LAD Bifurcation was a Guidant Frontier Multi Link (BMS) For RCA a Medtronic Endeavor (DES) Now getting odd pulsing sensations in the back of my leg (not the same side as catheter entry??) Very odd. Anyone any ideas?
tm from UK, January 6, 2007

• Mr. Parvizi -- I think you're the first documented case of late stent thrombosis from a patient posting in our Forum. We're so glad you were in the right place! As for the course of action, it is our understanding that stents cannot be removed via bypass (you'd have to open the coronary artery -- we don't think this is possible). Let us know if please if you find out something different.

We'd like to confirm one fact: that your stent had a late thrombosis and not restenosis. They are two different things. Thrombosis is a blood clot; restenosis is the reblocking of the stent due not to blood clots, but to regrowth of the arterial tissue -- if this occurs inside the stent, it is known as in-stent restenosis and is often treated by placing another stent inside of the original.
Angioplasty.Org Staff, Angioplasty.Org, January 6, 2007

• I am 62 years old male.Had two DES in LAD in June 2004, stopped Plavix after 1.5ys . On 21st Dec 06 while playing tennis had a mild heart attack, rushed into A&E where I had SCA. It was matter of luck that I was in a cardiac ward and was already wired up. Shock treatment brought me back and the following day was in the Lab which showed that one of the stents had Late Thrombosis and a small amount of blockage, so they have inserted another stent partially within the existing stent. I am on plavix and aspirin. I now have seen my own cardiologist (3rd Jan 07). He is very concerned and is worried that this second stent will also close and he is going to consult with other cardiologist for a possible by-pass to remove the stents as he thinks that my body is possibly reacting against the stents.My echocardiogram show no abnormality of the heart muscle with 55% plus ejection fraction even after SCA. He is going to make a decision in the next 24hrs of the next course of action. Any advise or comments will be appreciated.
Mr Bahman Parvizi, London, United Kingdom, January 4, 2007

• I'm confused about the size of the increased risk of late stent thrombosis in drug eluting stents as compared to bare metal stents. The number I see mentioned most frequently is the increased risk is only 1/200. However is this a yearly risk. So that over 2 years the risk is 2/200 and so forth...
Bill S., Maine, USA, January 3, 2007

• Since I was put on Coumadin for Afib my group of cardiologists felt that after being on plavix for 14 months post stents (three drug eluting in LAD) it would suffice to stop the plavix and just continue on the 10 MG coumadin daily in combination with 81 MG asprin....any thoughts regarding this combination and would the plavix be just too much in this situation...
Rick, New York, USA, January 1, 2007

• T.M. -- you describe something that has been reported by a number of posters in the topic "Not Feeling Well After Stenting" -- there are a number of possible reasons -- best thing is to do what you are doing, see your cardiologist. Please let us all know what you find out. Also, what type of stent (DES or BMS and what product?) did you get?
Angioplasty.Org Staff, Angioplasty.Org, December 31, 2006

• Hi All Some advice is sought please. I had a DES fitted to my RCA on 4th Dec 2006. As far as I know all went well, and indeed I had no problems at all following the procedure, until on Xmas eve, when I was woken at 2am by a chest pain that was the same pain in the same place as the original Angina. The pain subsided and i decided not to call the Emergency service The next day I noticed that the pain returned on the slightest exertion so I visited my Doctor who did an ECG with nothing abnormal detected. He has put me back on the Nitro patches I used before the Angio, which has indeed reduced the chest pain. I have a scheduled meeting with my Cardio on 2nd Jan, and my question is what sort of things should I be asking him in respect of what could have happened. This is the second stent I have had fitted this year, the other being a BMS on a bifurcation, which is apparently behaving itself, or at least was. Thanks for any advice.
T.M., United Kingdom, UK, December 31, 2006

• Lewis -- (1) read our "Patient Advisory" in the right-hand sidebar to get the most detailed information on thrombosis risk, but if you stay on Plavix and aspirin, you've lowered your risk. Whether you stay on this regimen past a year (which is now) is something you should discuss with your cardiologist. You did have a bleeding episode, and the Plavix and aspirin definitely has a side effect of bleeding -- this is why surgeon request that it be stopped before surgery, a problem for stent patients who need to stay on it. Talk to your cardio about the risks/benefits and let us know what you both decide.
Angioplasty.Org Staff, Angioplasty.Org, December 29, 2006

• I did not have an MI but after having difficulty with center chest pain and unable to complete a walk my doctor referred me to a cardiologist who did a heart cath to find a 96 , 60 and 40% blockages. with the 96 in the RCA, the doctor placed a DES. After about six weeks my energy level picked up. I began to feel better over all. I was placed on Plavix and one low dose aspirin, and Advicor daily. This event took place in Jan 06. All along I have had some episodes of chest pain or angina. With an adjustment to my blood pressure med (Lotrel and Toprol) I have much fewer problems. I am sorry to read about so many horror stories. I recently experienced some unexplained bleeding out thru my bladder for two days. (Extensive) The urologist ruled out tumor of bladder. I have two questions.
1. Am I at risk for thrombosis due to the DES?
2. Could the Plavix and aspirin have contributed to my bleeding? Thank you.
Lewis, Florida, USA, December 5, 2006

• Tom -- your concern is shared by many. (Read our recent article "Patients Worried About Safety of Heart Stents Turn To The Web" and also our Patient Advisory.) We also wrote a new feature about the Cardiosource editorial (we interview Dr. Kaul, the lead author). It's important to keep perspective. When you say that DES increases the odds of fatal MI's, we're talking about a very small increase, less than 1% for thrombosis. The cause of this increase is the matter of much debate and the subject of several new studies recently launched. To some extent it reflects patients not taking Plavix and aspirin long enough, or having to go off it for surgery or other reasons, not realizing that the odds of thrombosis increase with cessation of antiplatelet therapy.

At the recent TCT meeting a great debate among cardiologists took place, but no one is saying that DES are terrible. For the right patient, one with a higher risk of restenosis, they are a very excellent device. In fact, ostial lesions are known to be associated with higher rates of restenosis, so you may well be spared a second procedure or other complications because you got a DES in those. What we, and a number of cardiologists recommend, is that patients talk to their doctors when they are discussing stents. If the doctor is recommending a DES, find out why -- there are good reasons.

The criticism has been that they are being overused in some cases, when the older bare metal stents might do just as or almost as well. Also that the thrombosis issue may extend for a longer period of time than previously thought -- again a matter for debate. Use of DES in the US has dropped a bit -- it was almost 90% and now looks to be heading to the lower 80%, maybe lower (in Europe it's more like 30-50% DES). Stay tuned -- we'll be covering this very complex subject in more depth in the near future.
Angioplasty.Org Staff, Angioplasty.Org, October 28, 2006

• I do not wish to cause unnecessary concern, but in view of all the negative commentary over the last few months regarding the use of DES in place of BMS Stents, I am confused as to why a moratorium on their use hasn't taken place. For example, a recent posting on Cardiosource from two cardiologists is entitled: "Drug Eluting Stents: An Ounce of Prevention for a Pound of Flesh". This commentary seems to reinforce the contention that DES use increases the odds of serious and often fatal MIs among DES patients over BMS patients. I had 2 Cypher DES stents (1 to the ostium of the left anterior descending artery extending to the distal left main & 1 to ostial left circumflex artery extending to the distal left main) and 1 Driver BMS stent (to the proximal left anterior descending artery for treatment of dissection). They were all placed at the end of Feb.'06, and in view of all this recent data, I doubt that I would go that route now. Why do I still read on your site that DES is still routinely being used?
Tom, Arizona, USA, October 19, 2006

• Cheers Michael, and thanks for the kind words! Great to hear your good results and appreciate your advice. As for when should late stent thrombosis stop being of concern -- you've asked the $64, excuse me, €64 question -- right now the FDA has recommended 3-6 months of Plavix and aspirin. Many cardiologists prescribe Plavix for a year and baby aspirin for life. Some think Plavix for life. The US FDA will be meeting in December to discuss this situation. We also should have more info after next week's TCT meeting in Washington (we'll be there, covering it).
Angioplasty.Org Staff, Angioplasty.Org, October 17, 2006

• Your website is a wonderful source of information for many like me who felt isolated after a MI. Mine happened late Oct 06 after recent diagnosis of angina which suddenly turned unstable. One 2.5mm 18mm DES (Taxus) inserted LAD and results little short of miraculous. Keep up to speed via your site and others and get a little scared at some of the stories esp DES late stent thrombosis. But try to keep a sense of perspective. I urge all to follow the lifestyle changes esp medication, exercise,diet and reduce stress - in that order. Never been a smoker but if I was that would be top to quit. Question: At what stage,if any, would late stent thrombosis cease to be a problem or at least insignificant? Keep up the good work.
Michael W., England, October 16, 2006

• Lawrence -- it's hard to diagnose such an occurence long distance and without the imaging to judge. We have not heard of stents "contracting" per se. Once a stent is expanded (via balloon) it can't really shrink, but it can block up again. It's also possible that the stents were not fully expanded to begin with. If this happens, blood and tissue can build up in the small space between the stent and the artery wall, not unlike a shoe that doesn't fit -- you get a blister with a shoe. With a stent -- well, you get the point. Another phenomenon sometimes seen is called an "edge effect" where the edge of the stent becomes more prone to tissue build-up. If you have two stents (and two edges) next to each other, but not touching, the area between them might become more thrombogenic (prone to clotting). Hard to say exactly what happened, but we haven't heard of exercise causing anything like this. Exercise is a good thing.
Angioplasty.Org Staff, Angioplasty.Org, October 14, 2006

• I received 2 Taxus stents in March of 2004 in my LAD artery because of angina during strenuous exercise. On September 8 of this year, ten minutes after treadmill portion of stress test, I developed a clot, received tPA, etc. and then was shipped to a different hospital where the angiogram with ultrasound indicated that my stents had contracted and that there was a fuzzy area between my two original stents that was a possible source of the clot. The two Taxus stents from 2004 were re-expanded and I received two additional Cypher stents, placed partially inside the original stents. Do you have any information about drug eluting stents contracting? How often does it happen? What role does it play in stent thrombosis and how would a person know that their stents had contracted? Is it possible that exercise or vigorous exercise might play a role in causing stents to contract?
Lawrence K., New York, USA, October 14, 2006

• M. -- Ticlid is the brand name for ticlopidine. It is an antiplatelet drug -- that is, it reduces the blood's ability to clot. Ticlopidine or clopidogrel (Plavix) are always used in stent patients after stenting. Some people have adverse or allergic reactions to the drug (for more, see the Forum Topic on the right-hand side-bar "Plavix and aspirin: dosage and allergic reactions")
Angioplasty.Org Staff, Angioplasty.Org, October 14, 2006

• Hi all. My father who is 64 years old has been a cardiac patient for some time now. He once had a mild attack which caused some internal injuries and bleeding. He was told he could suffer from thrombosis at a later stage. At his last visit to the cardiac specialist treating him, he was prescribed Ticlid. I read a bit on this drug ( It says it is to reduce blood from clotting inside the veins. Has anyone ever taken this medication and can tell me more about it?
M., Pakistan, October 6, 2006

• Steve -- there are a few alternatives to clopidogrel (Plavix) such as Ticlid -- you should discuss this with the interventional cardiologist who did your procedure. Let him/her know you're having what you think is an allergic reaction to Plavix. Also check out our Discussion Topic on allergic reactions to drug-eluting stents.
Angioplasty.Org Staff, Angioplasty.Org, September 28, 2006

• I am 52 year old male, who thought he was in good health until I had DES placed after MI in May 2006. I have become increasingly worse over the past few months in several respects. After spending weeks of stopping and starting the various drugs (plavix, aspirin, topral, lisinopril, lipitor) I have pretty much concluded that the plavix is causing most of my problems (sores in mouth, itching, hypersensitivity of hands, feet, genitalia, unexpected reaction to heat and cold, fatigue, lethargy, chest and back pain). I have found that stopping plavix for one day every 3 to 5 days, gives me 2 days when I feel somewhat better, but not good. My DES was placed as part of the Endeavor IV clinical trial and the doctors refuse to tell me whether I have the Endeavor stent or the Taxus stent because it is a blind study. I understand that I am taking a risk by skipping doses of plavix, but I am not sure how much risk given the frequency of my skipping the drug, and the unknown stent. Just in the past week, i received a generic version of Plavix from my mail order drug plan. It is a bit smaller, darker shade of red, and appears to have diminished much of the allergy type reactions, itching hypersensitivity, etc. However, there has been no change in the fatigue, lethargy, and just general feeling bad. I find myself clinching my shoulders, arms, and back as if i am trying to protect myself from injury, all day every day. The cardiologists have been of no help whatsoever. My internist has found that my red blood cell count, hemoglobin, hemocrit, and other factors in CBC are low. He calls it a mild case of anemia and has treated my with steroids twice. they have offered some temporary relief, but only for a few days. This blood problem is presumably due to the 3 to 4 litres of blood loss incurred after my cardiac catheterization My femoral artery was damaged about 2 inches above the catheter insertion point, but the doctor did not realize it during the procedure. about an hour after the procedure I became severely ill from the blood loss and had emergency surgery. It has been almost five months and my blood tests are still abnormal, although the results do go up a little each month. Unfortunately that doesn't transfer to feeling a little better each month. I am now barely able to function on a daily basis. I am still working, but have to take at least one day off every week, and sometimes more. Luckily, I get a lot of vacation, but it is about to run out. during my hospital stay after the stent placement i was given 3+ litres of blood. One of the bags made me sick and after about 45 minutes I made them stop. they retested the blood and said it was OK, but I stalled letting them continue for a couple of hours. Once they restarted the blood had been hanging for too long, and they had to replace it with a new bag. After they brought the new bag and continued giving me the blood without incident. I feel certain something was wrong with that one bag. All of that explanation to ask this question: could mis-typed or bad blood given months ago, still be causing me problems?
steve shirk, , lawrenceville, ga USA, September 28, 2006

• Just wanted to add my observations. I am desperately sorry for all the people that seem to have had a bad reaction to stenting. But remember. 'You have to be alive to complain' Personally I had two Taxus Express drug eluting stents inserted on 30 May after becoming breathless very quickly when walking. Now...never felt better. Aspirin, Plavix, Bisoprolol,valsartan and Simvastatin are my cocktail. I may rattle when I walk but at least I am walking. Come on guys, be positive, you are still here. The only minor problem I have had is that when I went to my General practitioner for a checkup he said he would take me off Plavix after 3 months. I had to get my cardiologist to write to him and insist on keeping me on it for at least a year and preferably, 2 years to life. Best regards.
John K., United Kingdom, September 21, 2006

• Dr. Khalil -- first generation DES have permanent polymers -- there is some thought that the polymer does begin to break down after a couple of years. The drug elution is supposed to only occur in the first few months. DES like the CoStar (Conor Medsystems) is built with a bioabsorbable polymer that in effect turns the stent into a bare metal stent after 6 months. I think we'll be seeing more and more innovations with biodegradable polymers or no polymers in the future.
Angioplasty.Org Staff, Angioplasty.Org, September 20, 2006

• Hi, this is my second posting to you (the first on 4-8- 2006) I read all the latest DES news related to LAST (late angiographic thrombosis) the question is : Is there any way to avoid or at least delay this event? Is there any way to transfer a DES into BMS? How long does it take for a drug (in my case Zotarolimus) to be completely eluted? Is there any way to accelerate the elution? Apart from strict compliance with meds (especially the dual antiplatelet drugs) what else could be done?In other words how can we wash out the drug and If possible together with it the polymer? Cant we utilize the Tec of the CoStar to do so? I believe that our BROTHERS MANUFACTURERS might have some solutions to combat LAST?? I am very much obliged to your highly esteemed & useful site. Long live DES suffers!
Abdwl wahab Khalil, Dr Nabil Pharm EnterprisesK, Khartoum, September 18, 2006

• My cardiologist has told me on a couple of visits that clopidogrel therapy wasn't really necessary for life. We disagree. I told him that after 4 stents, I want to stay on it! My last PTCA was in June, when 2 stents were placed in the LAD. I'm having oral surgery in 3 days, and I was advised by both the oral surgeon and my cardiologist to discontinue the Plavix 5 days before the surgery. My oral surgeon said that I have a choice of staying on Plavix and bleeding to death after the extractions ("we can't suture bones") or taking a minimal risk of an infarction and stopping the Plavix. So I did. I stopped taking it yesterday and won't take it again until after the oral surgery, and until I stop oral bleeding. So you can imagine how nervous I am. What a choice to have to make!!
M.S., Florida, USA, September 17, 2006

• Stents are proven to be effective in : 'ST elevation' heart attacks, compared to clot-busting drugs and in high risk non-ST elevation acute chest pain episodes. BUT in stable angina - Single vessel disease: stents do not reduce mortality and may increase risk of future heart attack. In Multivessel disease bypass surgery is superior to stents in reducing mortality, angina and repeat procedures - though of course it's open-heart surgery. Overall, these procedures are for those with symptoms of angina IN SPITE of anti-angina tablets. what REALLY protects you from future adverse events are your aspirin and statin tablets, not the stent, which simply opens your artery and relieves angina.
Dr Mo Samuels, cardiology resident , University of London, UK, cardiology resident (, Sunday, September 17, 2006

• Thanks to the forum editor for clearing that up. I feel better about it now. It seems to be a case of pencil-whipping numbers to generate a scare. We've seen it before. On the patients who discontinued their antiplatelet therapy AMA, that's just common sense. And pretty ill-advised of them. I saw my cardiologist in August and she told me she plans to continue my clopidogrel therapy for life. I have no problems with that, and I don't plan to miss a single dose!
Kevin, Patient, Albuquerque, New Mexico, USA, September 10, 2006

• Kevin -- sorry, we didn't really answer one of your questions, about the 16% increase being called "statistically insignificant". First of all, Reuters was kind of mixing and matching. The study referred to was not about stent thrombosis. It was about the incidence of Major Adverse Cardiac Events (MACE) not just stent thrombosis. A MACE is defined as death, heart attack or revascularization (having to re-open the artery). The raw data from that study are that in the Taxus stent group 2.6% of the patients experienced a Major Adverse Cardiac Event (MACE) -- whereas in the bare metal stent group the number was 2.3%. This makes the actual increase 13% -- but given the quantity of patients studied, the statisticians calculated a "p-value" that is technically "NS" or "not significant". "P-values" are a much better way to compare the groups and they are used throughout these types of studies. They involve complex statistical analysis but it basically comes down to, based on the size of the population studied, the difference between 2.3% and 2.6% is "not statistically significant" because the difference falls within the normal variation that might be expected when comparing any two groups.

This was not the case for the Cypher stent, which showed a 6.3% MACE, compared with 3.9% in the bare metal group, which was definitely statistically significant. The figures quoted in the Reuters article were for "relative risk" in which these percentages have been adjusted, again using complex statistical formulae, in order to compare them to each other.

But again, this study was not about the occurence of stent thrombosi which Boston Scientific undertook on their own and determined that, while small in numbers, the difference with bare metal stents was "statistically significant".
Angioplasty.Org Staff, Angioplasty.Org, September 9, 2006

• Kevin -- we have written two recent articles about the increased risk of stent thrombosis with drug-eluting stents and are working on a feature which we hope to have up over the weekend. Check out the Drug-Eluting Stent NewsCenter. Late stent thrombosis is a complex issue and the "higher risk" is due to several things. More than a few patients in these studies were found to have prematurely ended their antiplatelet therapy, and this definitely increases the risk of thrombosis.

One big thing that patients can do is to be very conscientious about maintaining their prescribed antiplatelet therapy -- usually aspirin plus either clopidogrel (Plavix) or ticlopidine (Ticlid). The recommended period for taking this drug regimen is 3 months for the Cypher stent and 6 months for the Taxus -- and aspirin for life (aspirin has other benefits for heart patients). However, most cardiologists -- and we bet this number will increase even more after this week's news -- most cardiologists prescribe antiplatelet therapy for a year; some for life. This can get complicated if the patient needs surgery, which may entail going off Plavix, etc. for a short while. We recommended ALWAYS consulting your cardiologist before going off this medication during the time period he or she has prescribed for you. By the way, late stent thrombosis has been a concern since drug-eluting stents were introduced in the U.S. in 2003. Angioplasty.Org wrote an editorial at that time, and has consistently tried to publicize the critical importance of patients staying on their antiplatelet therapy -- one of the few places on the net where this has been done. Check out the "related topics" in the right-hand column.
Angioplasty.Org Staff, Angioplasty.Org, September 8, 2006

• This newsflash today is more than a little disturbing, as I have two Taxus 2 drug-eluting stents in place. I happened across it at where I have a brokerage account. They confirm an increased risk of blood clots/late stent thrombosis, and later dismiss a 16% increase as being "statistically insignificant". They go on to say that there is no increased risk to your health if you have one. How can an increased clot risk translate as "no increased risk" to my health? I smell a whitewash job. [Editor's note: here is a link to Kevin's Reuters story that you can read without subscription.]
Kevin, patient, Albuquerque, New Mexico, USA, September 7, 2006

• C.V.K. -- glad you got to the hospital quickly. That was the most important thing! This topic is about "stent thrombosis" -- something that can occur AFTER the stent is implanted. But thrombosis (clotting and blocking of the artery) is ultimately the cause of most heart attacks. It sounds like the angioplasty and stent cleared up the blockage. You call it a thrombotic occlusion (meaning the blood clotted and prevented the blood flow). Our question would be: did the cardiologist open up a physical underlying narrowing (stenosis) which may have provided the impetus for the thrombus to collect and form? Most likely there already was some type of obstruction in the ostial LAD. With that removed, the chances of another thrombus are reduced, but, as we're sure your doctor told you, if you feel anything out of the ordinary, especially for the next few months, go see him/her.

As for a blood test, perhaps one that tested your clotting factor, cholesterol, lipid levels, etc. We assume your cardiologist put you on blood thinners like aspirin and Plavix, both of which will help keep thrombi from forming. As for recovery of your full LV function, that's something that your cardiologist would be better at answering, if anyone can. So much depends on specifics of each patient. But "mild LV function" is much better than it could be, so keep active, reduce risk factors that you have control over, like diet and smoking, and take the prescribed medications. Hope this helps.
Angioplasty.Org Staff, Angioplasty.Org, September 6, 2006

• I am 41 years old slim built person. My BMI is 22. There is no visible fat deposition at all. Had a good habit of going for physical exercises daily like jogging / streching, games etc. No pre history of any pain in chest. Suddenly on 18.08.2006 had a severe myocardial infarction at 5am. The cardiologist did emergency coronary angiography. Conclusion : CAD single vessel disease Type III - 100% Ostial LAD throbomtic occlusion. Did primary PTCA + stent to LAD with 3.5x16mm yukon DES at about 2.45 pm same day. The report read there was TIMI 2 flow in LAD which improved after intracoronary SNP injection. Final angio showed good result. What does it mean? After 4 days, the Doppler echocardiography shows 44% pumping efficiency (simpson's), Left ventrical wall motion abnormal. Conclusion: mild LV dysfunction. The apical and mid septum and anterior wall are hypokinetic (LAD territory). Left ventricle inflow doppler shows altered A/E ratio indicating diastolic dysfunction. All other things are normal.

Now my question is what are the chances for my heart for recovering to its original condition? Is it possible?? if so how long will it take to improve?? Secondly is there any blood test to determine under what conditions or compositions of blood this thrombotic occlusions occur??
C.V.K. , INDIA, September 5, 2006

• Helpless -- first of all, you're not. You're looking up information and trying to help understand the situation. It sounds like your husband's is complex. We never recommend therapy or give medical advice, and in his situation you should be discussing the options with his doctor. BUT, what you are doing is very important: getting information that will help you ask the right questions and understand what your doctor is recommending. For example, what will a pacemaker do to help him? We suggest reading over our article You and Your Physician, -- make sure and write down a list of questions that you need the answers to. Part of getting better is understanding what's being done, what is the nature of your disease and, if you have it, how to best manage it. Good luck and please let us know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, August 19, 2006

• My husband had stents put in 4 arteries 2 weeks ago. Now his pulse rate is high. Is this possible due to a clot. because he is on dialysis and can't be dialysed because of his on-going pulse rate being too high. He is on plavix -- should he also take the ecroin aspirin, coumadin. Now the doctor talking about a pacemaker, please advise ASAP, before it's too late to help him.
Helpless, Baltimore, Maryland, USA, August 17, 2006

• T. in South Carolina -- stent thrombosis is a condition that occurs in only 1 or 2 out of 100 patients. But when it does, it occurs acutely -- sudden and unexpectedly -- and is usually accompanied by pain -- it is, in effect, like a heart attack. It is very different than restenosis, which is a gradual reclosing of the arterial segment that was originally opened. The risk of stent thrombosis is greatly lessened by taking your prescribed antiplatelet medication: usually aspirin plus clopidogrel or ticlopidine (talk to your doctor about this if you're not on it).
Angioplasty.Org Staff, Angioplasty.Org, August 8, 2006

• My husband has had 5 heart caths in less than a year. One stent in 11/05 2 more stents last week to extend the 1st one. Another cath. last week because of a blood clot the Dr. says. He could not climb steps without almost passing out. Now he has no energy and I just read about the SAT. Any response on the energy. Can't get anywhere with the Drs. Should we be concerned about the SAT?
T., South Carolina, USA, August 6, 2006

• Kevin -- glad to hear your story. It's important to emphasize that your "textbook" case is the norm for the majority of patients. Where you're out of the norm is that you actually wrote to this Forum with a positive outcome. As we've written, pretty much all a reader sees here are the "horror stories". We get these because patients who have not had a good experience often can't get any resolution or information about their problem, so they turn to the Net, Google their question -- and there we are! So what you read here is a highly distilled and concentrated mixture of complications and adverse events -- the Forum can be sort of like "The Complaint Department".

That being said, it is our opinion that many, if not most, of these reports are not to be found elsewhere. For example, how many posters have formally reported these problems to the F.D.A.? It is extremely important to keep information about complications in the forefront because as Andreas Gruentzig, the inventor of coronary angioplasty, said in 1985: "I am speaking all the time about complications...Well fortunately those complications are rather minor, in percentage. The reason I speak up about complications -- it is not because it is such a major problem. But it is always my major concern in selecting patients or treating patients." (see the video clip.) He believed that complications were extremely important in learning what went wrong in order to improve the procedure.
Angioplasty.Org Staff, Angioplasty.Org, August 6, 2006

• These horror stories I've been reading here have gotten me apprehensive, to say the least! My cardiologist painted a much rosier picture for my prognosis. She basically said that in 6 months all heart muscle damage will have repaired itself, and my outlook is excellent, especially now that I am on Lipitor. I have to agree because I feel fantastic since the stents were implanted. I realize now how many subtle, unidentifiable symptoms I was suffering from while I had the two blockages. I feel rejuvenated, and am endlessly thankful for that. I feel so bad for some of the people I've been reading about here. My gosh, some of the complications are terrible. The thrombosis, the femoral artery problems ...the sudden deaths, the whole slew of other problems people here have experienced ..... I feel guilty having had such a stress-free and positive experience having my stents installed. I wish there was something I could do to help you all. Chalk my experience up as one of the textbook cases. I am very fortunate.
Kevin, Albuquerque, New Mexico, USA, August 4, 2006

Lori, Sorry to hear about your loss. Having been 1 year out from stent placement, it would be acceptable to stop the plavix, but often for minimal invasive surgery, many surgeons do not feel stopping the plavix is absolutely necessary. Although no one would know for sure exactly how your mother died, it would seem more likely due to pulmonary embolism than stent thrombosis. She was at risk for pulmonary embolism due to recent surgery and lying in bed immobile during the recovery period. With stent thrombosis, although one can die, they usually have significant chest pain due to an acute heart attack the moment you have stent thrombosis. The other possibility of death is due to an abnormal heart rhythm causing sudden cardiac death. If she had a weakened heart, she would have been at increased risk for this. Obviously you will never know for sure what was the exact mechanism, rest assured it was not a deviation from standard of care to have had the plavix stopped 1 year after stent placement for upcoming surgery. I do think that the likelihood of death was due to massive pulmonary embolism, but obviously no one can be sure without having had an autopsy.
F. L., North Carolina, USA, July 26, 2006

• Many thanks for your prompt reply and for the data on the subject. It's nice not to feel alone out there - Keep up the good work!!
Rick, New York, USA, July 19, 2006

• Rick and others -- the topic of how long patients sould stay on antiplatelet therapy (clopidogrel, a.k.a. Plavix) after drug-eluting stent placement is a topic of great discussion within the profession. There have been many symposia and PowerPoint presentations about this subject, and opinion varies. A recent example is an unscientific poll conducted earlier this month on a cardiologists-only web site which asked just that question. About 100 cardiologists responded. Only 2% of the docs answered 3 months and only 25% answered 6 months -- the current FDA recommendations for the Cypher and Taxus stents respectively. So only 27% of the cardiologists in this poll prescribe what the FDA has stated as a minimum recommendation. 40% said a year. Over a third said "Plavix for life". Does that mean you should stay on Plavix after a year? Not exactly. Each patient is an individual with unique medical needs and a specific clinical situation. For example, patients on the blood-thinner coumadin present a different situation, and clopidogrel does carry a risk of bleeding. That is why nothing you read on this (or other) sites should be taken as "medical advice" -- these kinds of decisions should be made by each patient's physician, with that patient's history and medical records in hand -- in consultation with the patient, of course.
Angioplasty.Org Staff, Angioplasty.Org, July 18, 2006

• When you say "late stent thrombosis"...what is considered as late? One year ago had three drug eluting stents placed in LAD. Since am now on coumadin for a-fib my group of cardiologists feel that one baby aspirin plus the coumadin is sufficient and have advised me that the plavix is no longer needed. Am a bit confused and would appreciate your thoughts.
Rick, New York, USA, July 18, 2006

• One year ago my mother had a coated stent implanted and was put on Plavix and aspirin. Four weeks ago she had out-patient arthroscopic surgery for a torn meniscus, a procedure that lasted 10 minutes. She was told to stop plavix and aspirin 5 days prior. She died suddenly at home 20 hours after the procedure. The death certificate stated a possible pulmonary embolism. We'll never know for sure if that was the cause of death or a clot formed in the stent (no autopsy). We're heartbroken. Just want others to be aware of the danger of going off Plavix for minimally invasive procedures.
Lori, Charlotte, North Carolina,USA, June 1, 2006

• Caren, yes, my father also died from a stent (j&j) in 2003. He had the some thing your father had. I feel it`s the stent that did it. I would like to have more feedback on this matter too.
judy, levittown, New York, USA, May 6, 2006

• Dear Caren -- Sorry for your father. I'm Gerrie from Holland and 44 years old. In May 2005, I got a Taxus stent in the left coronary artery. I experienced (sometimes) severe chest pain and uncomfortable feeling caused by artery spasms by the stenting. After half a year, the Plavix treatment ended. My blood became thicker and in 10 days a had a mild heart attack. I was just on time in the hospital to prevent an infarct. The heart attack (unstable angina pectoris) was caused by blood clogging at the front of the stent. The clogging, no longer prevented by the Plavix, was generated by artery wall injury caused by the ever present artery spasms. A second stent was implanted and the Plavix is continued. Now this time 30 April 2006, I still experience chest contractions caused by artery spasms. Greeting from Holland and don't hesitate to contact me.
Gerrie L., Netherlands, April 30, 2006

• Caren, we are most sorry for your family's loss. Sub-acute thrombosis (SAT) occurs in less than 1% of stents, and usually within days after a stent is implanted. (There is another type, called Late Stent Thrombosis, which is a different story -- see below.) What happens in SAT basically is that the platelets can become activated by the stent and then begin to aggregate at the stent site, causing a blood clot or thrombosis. Antiplatelet therapy to prevent this is often started prior to stenting, and is critical after stenting. The Plavix-aspirin combo you indicated he was on is the recommended medication. All stents have this risk. There has been concern about higher thrombosis rates in the newer drug-eluting stents, and shortly after the CYPHER was approved, the FDA issued a warning letter about this risk after deaths were reported. We covered this topic in depth in our article "Unraveling the CYPHER". But, after the situation was studied, the SAT rate of the CYPHER or other drug-eluting stents did not seem to be higher than that of bare metal stents -- in fact the CYPHER showed a 0.7% SAT rate. The FDA withdrew its warning about drug-eluting stents. But SAT remains a dangerous complication of all stenting. Sometimes it is caused by the stent being in poor apposition, not conforming to the curves of the arterial wall perfectly. This leaves a small "space" where platelets can gather. Sometimes the stent is underexpanded. There are several causes, not all predictable.
Angioplasty.Org Staff, Angioplasty.Org, April 22, 2006

• Hello all, My father just passed away four weeks ago. I spoke to the surgeon myself and he is sure that is was a subacute thrombosis. He was on Plavix and 325 of aspirin. My father was somewhat overweight and was "borderline" diabetes. I am trying to talk about this and get some feedback. The research I have done on the internet puts him in a very low risk of developing a clot. He passed 10 days after his second set of stents. Any one heard of such a thing? Thanks, Caren
Caren, Austin, Texas, USA, April 20, 2006

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