Magazine article Drug Topics

Do Drug-Eluting Stents Carry Thrombosis Risk?

Magazine article Drug Topics

Do Drug-Eluting Stents Carry Thrombosis Risk?

Article excerpt

Drug-eluting stents (DESs) greatly reduce the chances of restenosis, a gradual growth of abnormal cells within the stent. However, the results of a new study reveal that DESs may also put patients at a higher risk for a sudden and potentially fatal thrombosis.

Data from the BASKET-LATE trial showed a more than threefold increase in death or myocardial infarction (MI) with DESs in the year after clopidogrel (Plavix, Sanofi-Aventis/Bristol-Myers Squibb) discontinuation. Clopidogrel along with aspirin is usually prescribed for the first six months to a year following stent placement. The new data suggest that the current antiplatelet regimen may not be long enough to provide adequate protection from late thrombosis with DESs.

The researchers noted that for every 100 patients treated with a DES, 3.3 cases of cardiac death or MI are induced. However, the researchers also said that further study on late thrombotic events with DESs is strongly warranted. It is also important to explain that the study was a meta-analysis as opposed to a full-blown clinical trial that would hold more weight. However, the findings did raise eyebrows regarding the grave consequences of late thrombosis.

Ironically, the same drug used to coat DESs-which prevents restenosis by inhibiting abnormal cell growth within the stent walls-also inhibits the growth of normal cells, called endothelial cells, that would prevent the bare metal of the stent from being exposed to the blood. The theory is that when antiplatelet drugs such as clopidogrel are stopped, platelets in the bloodstream may be more likely to stick to the stent and form a clot.

So it's kind of a double-edged sword, said David Brown, M.D., chief of cardiology at Stony Brook University Hospital, in New York. "The good news is the drugs prevent the in-growth of smooth muscle cells; the bad news is they may also prevent the in-growth of endothelial cells, which are what you need to reduce the thrombotic risk," he said. …

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