ANTICOAGULATION IN PATIENTS WITH DRUG-ELUTING STENTS
How long should patients who have had coated stents implanted in their coronary arteries take clopidogrel (Plavix)?
—Marilyn Otero, RPA-C, New York City
Drug-eluting stents have only been available since 2003. Because no long-term studies have been conducted, the length of anticoagulation remains unclear.
According to the American Heart Association, there are conflicting data on the magnitude and significance of increased risk of late thrombosis in patients with stents. The FDA recommends three to six months of Plavix along with aspirin. An observational study showed that use of Plavix for at least one year (and possibly indefinitely) is recommended (JAMA. 2007;297:159-168). Researchers have concluded that patients with coated stents should remain on Plavix and aspirin (if possible) until adequate data from studies become available (J Am Coll Cardiol. 2006;48:2584-2591). Of course, each patient should be evaluated independently, and the side effects of Plavix should be taken into consideration when determining its duration.
—Debra Kleinschmidt, PhD, PA (105-6)