Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy (original) (raw)

Stent Thrombosis in the Era of the Drug-Eluting Stent

Korean Circulation Journal, 2005

Coronary stent thrombosis (ST) has been regarded as a rare but catastrophic complication of bare-metal stent (BMS) implantation that normally occurs during the first few weeks after stenting. In the drug-eluting stent (DES) era, there has been increasing concern regarding higher rates of ST due to delayed endothelialization. However, a pooled meta-analysis of randomized clinical trials and registry studies showed rates of ST (0.4-1.5%) after DES to be similar to those of BMS. The rate of ST did not differ between sirolimus-and paclitaxel-eluting stents. Additionally, the rates of late ST were similar between DES and BMS. Remarkably, very late occurrence of ST, which develops up to 1-2 years after DES implantation, was significantly associated with complete cessation of antiplatelet therapy. Further large-scale studies are needed to determine the optimal combination and duration for antiplatelet therapy in order to prevent these serious thrombotic events.

Late thrombosis in cypher stents after the discontinuation of antiplatelet therapy

Cardiovascular Radiation Medicine, 2004

Drug-eluting stents, since their approval in the United States, have become the treatment of choice for de novo coronary artery narrowing due to their ability to reduce restenosis and the need for repeat revascularization. We present two patients who underwent percutaneous coronary intervention for the treatment of multivessel coronary artery disease; both patients were treated with sirolimus-eluting stents (SES) and bare metal stents (BMS).

Analysis of 36 Reported Cases of Late Thrombosis in Drug-Eluting Stents Placed in Coronary Arteries

American Journal of Cardiology, 2007

Drug-eluting stents (DESs) have decreased the incidence of in-stent restenosis. Within the past 2 years several cases on late stent thrombosis (LST) have been reported. This study analyzed and reviewed all published cases of LST in DESs to explore possible trends not previously reported. We applied a Medline search using the key word "drug eluting stents." All 845 positive matches in March 2006 were screened for case reports of LST in DESs, defined as angiographic stent thrombosis >30 days after deployment. We included reported LSTs from randomized trials, observational registry reports, and letters to the editor if information regarding timing from stent deployment to clinical event, vessel, stent diameter and length, and antiplatelet regimen were available. There was no significant difference in the incidence of LST between sirolimus-and paclitaxel-eluting stents. Median time from stent deployment to clinical event was 242 days (total range 39 to 927). If aspirin and clopidogrel were discontinued, median time to clinical event was 7 days (3 to 150). In comparison, if only clopidogrel was discontinued, median time to clinical event was 30 days . There was no significant difference in stent diameter and length between sirolimus-and paclitaxel-eluting stents. Forty-two percent of events occurred in relation to a surgical procedure for which the 2 antiplatelet agents or clopidogrel alone was discontinued. In conclusion, there was a strong association between occurrence of LST and cessation of dual antiplatelet therapy. Patients who continued on aspirin had a significant delay to the clinical event. Efforts should be made to maintain patients on aspirin during routine surgical procedures.