Doctors question drug therapies after cardiac stent surgery

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By Michael White, Pharm.D., FCP, FCCP

UConn School of Pharmacy

Over 1 million cardiac stents are placed into the hearts of Americans each year and afterwards patients are given two anti-platelet drugs to take for 12 months. Is 12 months the optimal amount of time to be taking these drugs or is a longer time period needed?

A stent is like metal scaffolding that is placed in the arteries of people with blockages in their heart to hold the vessel open after balloon angioplasty. The balloon is inserted into a leg artery, is threading up to the heart and goes into the coronary arteries where it finds the blockage, then the balloon is inflated, opening the artery and deploying the stent, when the balloon is deflated and removed, the stent remains in place. There are two types bare metal and drug eluting stents. The drug eluting prevent muscle cells in the artery from becoming activated and decreasing blood flow from that mechanism and most people get these types of stents.

The stent is made out of metal that sits against the inner lining of the artery. The risk of platelets becoming activated and then causing a blood clot that shuts off blood flow is very high. However, like a tree next to a fence, the inner lining of the artery will overgrow the stent so that blood doesn’t touch it anymore. But how long you need to be on two anti-platelets to prevent platelet activation has been hotly debated among the experts. Clinical trials were only one year long and showed great results but does that mean that if you took two anti-platelets for more than one year you would do even better? We haven’t had the answer until now.

In the ARTIC trial, a multi-center trial conducted primarily in France and published in the journal Lancet, they found that there were not additional benefits to continuing the two anti-platelet drugs versus simply continuing with one anti-platelet drug after one year of therapy. This is great news for cardiac patients who are already taking many drugs and can now talk to their doctors about whether or not they can stop using the extra anti-platelet drug one year after they had their stent. It is never a good idea to stop taking drugs on your own so check with your doctor before making any changes. The qualifier is that the people in this trial didn’t have a hospitalization for heart disease during the year after their stent was deployed and if you are having those types of issues, there may be advantages to continuing after one year.

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