Drug-eluting stents: A Mayo Clinic doctor discusses their pros and cons.
Charanjit Rihal, M.D.
In recent years, there has been some concern about the use of some types of popular medical devices called stents. Stents are used to keep arteries open after a procedure called angioplasty. More than 2 million people receive stents each year, including a million Americans.
Some studies have suggested a certain type of stent known as a drug-eluting stent might increase your risk of heart attack. Other studies didn't find much risk.
Charanjit Rihal, M.D., a cardiologist and director of Mayo Clinic's Cardiac Catheterization Laboratory, Rochester, Minn., answers some questions about stents.
Why is there some concern about using drug-eluting stents?
The Food and Drug Administration (FDA), which monitors the use of medical devices, considers both bare-metal and drug-eluting stents to be safe and effective in most people. But, all stents involve some risk. Sometimes the angioplasty procedure itself can cause complications such as a heart attack, blood clots, bleeding or injury to the blood vessels. Both bare-metal and drug-eluting stents have a risk of clotting both early and late after implantation.
It appears that in some people who get drug-eluting stents, there's a small increased risk of blood clots forming in the stent once the drug coating has been used up — sometimes a year or more after stent implantation. This risk is still quite low; about 0.5 percent or less when stents are used for FDA-approved reasons. The risk appears to be slightly higher when drug-eluting stents are used for off-label uses, ranging from about 0.4 to 1.6 percent.
What should you do if you have a drug-eluting stent?
It's very important that you take anti-clotting medications exactly as directed by your doctor. Here's what to do if you have a stent of any kind:
- Take aspirin. If you have a stent, you'll have to take aspirin daily and indefinitely to reduce the risk of clotting.
- Take anti-clotting medication. People with stents are given prescription anti-clotting medications such as clopidogrel (Plavix). The American Heart Association and FDA recommend that people who have had drug-eluting stents inserted should continue to take medications such as Plavix to reduce the risk of blood clots for at least one year after the stent is inserted.
- Listen to your cardiologist. Always talk with your cardiologist about how long you should take anti-clotting and other medications because the answer will vary depending on the nature of the blockage you had and your risk of bleeding. The most important thing to remember is to take all your medications exactly as your doctor prescribes.
If you're considering noncardiac surgery (meaning, not related to your heart) in the year after receiving your stent, there are some additional things to keep in mind:
- If possible, you should postpone your noncardiac surgery for one year after receiving a stent.
- If the surgery can't be postponed, discuss with your doctor medications you should be taking at the same time, such as aspirin or clopidogrel. Your medication dosages might need to be changed.
Last Updated: 07/19/2008
