Title: Prevent Early Discontinuation of Antiplatelet Medications in Patients with
Coronary Artery Stents
Your patient may be taking anti-clotting medications (aspirin and clopidogrel or Plavix) following a coronary artery stent procedure. A coronary stent is a wire mesh tube that is implanted permanently into a blocked artery to restore blood flow to the heart. Patients can receive either a drug-coated stent or a plain metal stent. As with any medical procedure, both uncoated and drug-coated stents are associated with risks. One rare but serious risk for both types of stents is the formation of a blood clot inside the stent, also known as stent thrombosis. Stent thrombosis can potentially lead to a heart attack or even death in some cases. Fortunately, the rates of stent thrombosis are low.
To reduce the risk of stent thrombosis post-stent implantation, patients are prescribed dual antiplatelet therapy. Most commonly, patients are prescribed aspirin and a second drug- clopidogrel (also known as Plavix) or ticlopidine (also known as Ticlid). Patients usually take aspirin for life, and clopidogrel or ticlopidine for several months or even years.
In February 2007, the American Heart Association, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, the American College of Surgeons, and the American Dental Association published their consensus opinion about drug-eluting stents and anti-platelet therapy. The advisory document states that healthcare providers who perform invasive or surgical procedures (i.e. dentists) and are concerned about periprocedural and postprocedural bleeding should contact the patient’s cardiologist regarding the patient’s antiplatelet regimen and discuss optimal patient management, before discontinuing the antiplatelet medications. Given the importance of antiplatelet medications post-stent implantation in minimizing the risk of stent thrombosis, the medications should not be discontinued prematurely.
For further information about the recommendations from the scientific advisory, you can access the original publication: Grines, Cindy et al. Circulation. 2007;115:813-818.
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