Stents and Sensibility
What medical consumers need to know about the flap
What should you do if you're among the millions of Americans with a drug-coated stent protecting your heart–or might be a candidate for one? Here's a dose of personal guidance.
My cardiologist is recommending a coated stent. What's my real risk?
Studies suggest that the risk of a potentially deadly clot because of a coated stent increases by about 0.5 percent a year, year after year. Because you intend (right?) to improve your diet, exercise, and lower your cholesterol, your risk of a heart attack over the next year might be around 10 percent. Increasing it to 10.5 percent means your odds of being alive at the end of the year drop from 90 percent to 89.5 percent. How worrisome is this? Your call.
How do I know if I might be a candidate for a bare-metal stent instead?
The problem with bare-metal stents is that tissue regrowth may gradually plug up the artery again. The ideal bare-metal candidate, says Sidney Smith, director of the Center for Cardiovascular Science and Medicine at the University of North Carolina-Chapel Hill, is not on the table because of a heart attack, does not have diabetes, and has a defined blockage, in a large artery, that is away from any branches. All are factors that influence the chance of reblockage.
Is one kind of drug-coated stent better than another?
For now, most cardiologists consider them about equal.
What's the best clot protection?
Taking clopidogrel (Plavix) faithfully for as long as your physician tells you to do so. It stops platelets from clumping at the site of the stent, where tissue has been injured.
Is Plavix dangerous?
A very small percentage of those on the drug experience bleeding that calls for medical attention; an even smaller percentage may have an allergic reaction. It also tends to cause easy bruising from bumps and falls.
How expensive is it?
Very: $3 to $4 per daily tablet. Some health insurers, moreover, might not cover it after a stent implant; others may resist paying for it after the labeling period of three months for the Cypher coated stent and six months for the Taxus coated stent. Aetna is among insurers that are willing to cover the drug indefinitely. The Bristol-Myers Squibb Patient Assistance Foundation (800-736-0003) will supply the drug at no cost to those on limited incomes and with no coverage.
Can a stent be removed?
No. In a few months, new tissue has grown over the stent wires. That's part of the healing process.
I got a drug-coated stent six months ago, and I've been taking Plavix. My cardiologist says I can stop. Is that safe?
It is worth another conversation with the doctor. Many cardiologists now keep such patients on the drug indefinitely.
I need minor surgery. The pre-op instructions say to stop taking aspirin and antiplatelet medications five days before the procedure. What should I do?
Definitely contact the cardiologist who put in your stent. Some heart specialists feel strongly that the risk of bleeding excessively in a surgical procedure because of anticlotting medication is counterbalanced by the risk of a clot if you stop. Others feel equally strongly the other way. You should have such a discussion before dental work and screening procedures such as a colonoscopy that could produce bleeding, too.
This story appears in the December 11, 2006 print edition of U.S. News & World Report.
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