Stent Thrombosis

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"):

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 (http://www.drugdelivery.ca/s3649-s-TICLID.aspx). 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 (j.zaman@ucl.ac.uk), 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 Fidelity.com 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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