Heart Health: What to Do If You Have a Drug-Eluting Stent
Don't stop the Plavix and aspirin. That's the latest advice for people who have a mesh cylinder known as a drug-eluting stent propping open a clogged artery, issued today by a group of medical societies. The two-drug regimen–known as anti-platelet therapy–should be continued for a year after getting a stent, or the patient runs a risk of dying from a blood clot. And if that means putting off an elective operation or dental surgery that calls for discontinuing these drugs to minimize bleeding, put it off if at all possible.
"This is a no-brainer. The science is very clear cut," says Ray Gibbons, a cardiologist at the Mayo Clinic and president of the American Heart Association, which co-authored the advisory appearing in the journal Circulation. Drug-eluting stents have been caught in a whirlwind of controversy since last fall, when evidence became public that while the devices did a great job of keeping arteries open, they also could produce blood clots that led to heart attacks and strokes. The drugs, if taken for a year, greatly minimize the risk of these clots. But if they are stopped early, the risk shoots up 20 to 45 percent, according to various studies. Cardiologists have known about this, but other doctors have not been brought up to speed, and that's one of the major reasons behind today's report.
"There are lots of reasons people discontinue drug therapy," says cardiologist John Hodgson, president of the Society for Cardiovascular Angiography and Interventions, another group behind the advisory. "A patient gets a stent, goes home, and in a few months sees his family physician for a checkup. The physician finds some nodules in the prostate and schedules a biopsy, and tells the patient to stop taking Plavix because it increases bleeding during surgery. And boom! The patient drops dead of a heart attack."
The cardiologists aren't saying stent patients shouldn't have biopsies or other surgeries, Gibbons hastens to add. "But patients and other health providers need to be aware of the risks of stopping the drugs and balance them with the importance of the surgery." Sometimes you can go ahead with an operation and there's a just a little more blood. Sometimes it's best to postpone the surgery until the one-year window is finished.
Sometimes patients stop taking drugs because of the cost, which can run about $4 per day. "Patients and doctors need to discuss these things before the stent is implanted," Gibbons says. "If the cost is prohibitive, or the patient has some surgery coming up that can't be avoided, perhaps the stent implant should be postponed." Another possibility, if the medical situation warrants, is to use a stent not coated with drugs, although they are not as effective at keeping arteries open. Drug-eluting stents can be lifesavers, but without the anti-platelet drugs they could be life enders too.
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