The Risk Of Drug-coated Stents Can Be Managed
By Ng Peng Hock
Despite the recent negative news that patients with drug-coated stents have higher risk of blood clots than those with bare metal stents, a pioneer of the drug-coated stent has said that with proper medication, that risk can be managed.
According to Professor Patrick Serruys from Netherlands' University Hospital in Rotterdam, drug-coated stents are as safe as bare metal stent in the first year after they are implanted, as long as patients take two blood-thinning drugs. The risk of blood clots occurring in subsequent years is actually very low, at 0.6 percent. In contrast, the risk of blood clots for those who had undergone a procedure to clear a clogged artery without implanting any stent are at a higher risk, 3 to 5 percent, of developing blood clot.
Without stent, about 40 percent of patients will have their arteries clogged up again. The bare metal stent will cut the rate to between 20 and 30 percent. For some patients, however, the artery would still narrow as a result of excessively scarring of its walls. Therefore, drug-coated stents was introduced in 2000. It is believed that the slow-release drug coated will stop the excessive scarring thereby cutting down the rate of blockage to less than 10 percent.
Recent studies, nevertheless, indicated that some patients using drug-coated stents developed blood clots more than a year later. A choked artery can trigger life-threatening situation such as heart attack. This is rarely happened in patients with bare metal stents.
Patients with bare metal stent implanted have a 0.2 to 0.8 percent chance of developing blood clots in their first year comparable to those on drug-coated stents. The risk can be kept low if patients take two drugs, aspirin and clopidogrel, to thin the blood so as to reduce the risk of blood clots forming.
Those using bare metal stents usually take the 2 drugs for just 2 to 4 weeks, and subsequently continue with aspirin. Without the 2 drugs, the risk of blood clots forming on any stent is 20 percent.
According to Professor Serruys, patients who have had blood clots form on their drug-coated stents tend to be higher-risk patients: those who smoke or have diabetes. Most stopped their blood-thinning medication, too. Many were also patients for whom the drug-coated stents had not been approved specifically. This is known as "off-label" use. The "off-label" use of drug-coated stents in United States has been estimated to be 60 percent.
It is advisable for patients with drug-coated stents to continue taking the two blood-thinning drugs for at least a year. They should also discuss with their cardiologist if they have to undergo other non-heart procedures or operations that require them to stop taking the drugs.
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