Thursday, January 25, 2007

Hmatter FAQ on DES

Note: This FAQ is the Hmatter opinion on DES. If you'd like to use it somewhere else then let us know by telling us in comments where you'd like to post this.

FAQ ON DES (Drug Eluting Stents)

Having been implanting DES since the year 2002, the initial euphoria is slowly dying down. More people, including those not on already DES are asking questions about DES. When we first started, there was only the Cypher (JnJ) stent. After that, came the Taxus (Boston Scientific) Stent.

Now we have the Endeavor (AVE metronic), The Coroflex Please (B Braun), and more recently the XienceV (Abbott) stent. The first two are FDA and CE mark approved, while the latter three are only CE mark approved. There are a few more DES that are CE mark approved only like the Genous (Orbus Niche), the Costar (Conors), and many others (some I don't even know). The marketplace here is getting very crowded.

Patients and potential patients are asking more questions about these DES. This curiosity is in no small way driven by the heavy press coverage in the media. Since bad news sells it follows that most of this is misinformation. After Barcelona 2006 one media outlet trumpetted "Timebomb in your heart". How sensational, how eyecatching, how misleading. They have their job to do and in order to do their job the maxim "if it bleeds then it leads" obviously sells more papers or catches more eyeballs.

I certainly feel that these kind of sensational headlines are plain unfair and irresponsible. These are the top 3 questions are most often asked.

Q. Doc, I hear that these new medicated stents are killing patients?

A. There is no evidence to say that DES have a higher mortality when compared to the use of bare metal stent ( BMS ). This conclusion was arrived at by the expert panel, chaired by the circulatory device committee of the FDA. After looking into all the data, the expert panel concluded that although late stent thrombosis was more frequent with DES, there were no increase mortality.

Q. Will the stent move after implantation, and can it be removed and changed, if they block off?

A. No, once properly implanted, the present type of DES will neither move, nor can they be removed and replaced. There is ongoing research to invent a DES that is absorbable like the sutures that surgeon presently use in surgeries, eg in gallbladder removal, or worm removal. However, the present absorbable DES being tried, have not yielded good enough results, although they seemed safe to use.

Q. Must I take medicine after DES, if so, what kind?

A. After DES implantation, the patient will need to take, heart artery relaxing pills like calcium channel blockers (e.g. diltiazem). They will also need blood thinning pills, including aspirin and Plavix. Dual anti-platelet therapy (aspirin and plavix) is absolutely vital. Both for 6 months at least, and thereafter, plavix for the next 6 months. So the total length of plavix should be 1 year at least. Some patients may need to have plavix even for longer. Patients who are know to be allergic to plavix, should not get DES.

Then there are the other medications for preventing heart artery disease like cholesterol lowering medications, and where necessary, blood pressure and diabetic pills. Let us emphasize that plavix for 1 year is absolutely vital, as the majority of patients who suffer late stent thrombosis after DES, are those who had prematurely stopped their plavix.

I hope that this will help. If there are other questions that need answers, please feel free to ask. Do not let unfounded fears keep you from benefiting from DES.

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