Monday, June 05, 2006

Plavix and late stent thrombosis

One of our readers commented on this post as follows:

Lately I have seen some tendency to use bare metal stents rather than DES in patients that are pre-op or have an anticipated procedure such as EGD w/dilation. (We refer our PCI patients to a tertiary facility - only do diagnostic cath).
Many of my DES patients are told (erroneously) by their GI doc or dentist or PCP that it is OK to stop both ASA and Plavis peri-procedurally. One of my biggest teaching points with patients is to tell them never to stop both drugs during the first 6 months post PCI, and that doing so after 6 mos is not without risk. Innovations that reduce the risk of thrombosis would be welcome indeed.

Thanks for the comment

You are right. We are in a dilemma as to how long to continue plavix. We know that there is a 3% incidence of late stent thrombosis in patients who has a DES. These could be due to many reasons. 30% of these late stent thrombosis is due to discontinuation of plavix. Other reasons include renal failure and diabetes. So we are currently advising that plavix should be continued for 1 year, despite the cause.

I do not understand what you mean by refering your PCI patients to a tertairy facility for diagnostic catheter? Are you suggesting that we should use diagnostic angiogram to predict the possibility of late stent thrombosis? I know of no evidence to support this idea.

As for the future, we have stents that have very, very low (some say zero) incidence of late stent thrombosis, like the new Endeavour stent and Genous stent. However we are concern, that the available data at the moment suggest that these to stents have a higher than acceptable "late loss " suggesting that they may have a higher than acceptable restenosis in the long term.

1 comment:

huajern said...

Sorry, could you please explain the difference between 'late stent restenosis' and 'late loss'?