Featured Research

from universities, journals, and other organizations

Clinical Alert On Drug-eluting Stents And Late Thrombosis

Date:
January 11, 2007
Source:
Society for Cardiovascular Angiography and Interventions
Summary:
The Society for Cardiovascular Angiography and Interventions (SCAI) today released a clinical alert advising physicians on practical steps for reducing the risk of a rare but serious complication associated with drug-eluting stents. The document follows hearings held by the FDA's Circulatory Systems Device Panel. SCAI's clinical alert focuses on careful patient selection, meticulous stent implantation, and consistent use of medications to prevent the delayed formation of blood clots that can block blood flow to the heart.

The Society for Cardiovascular Angiography and Interventions (SCAI) today released a clinical alert advising physicians on practical steps for reducing the risk of a rare but serious complication associated with the use of drug-eluting stents. The document follows hearings held by the Food and Drug Administration's Circulatory Systems Device Panel regarding the use of these devices. The panel supported the continued use of these devices but also suggested more research to determine whether the devices contribute to an increased likelihood of heart attack and death in complex heart disease patients who receive these stents.

SCAI's clinical alert, published online in SCAI's official journal, Catheterization and Cardiovascular Interventions, focuses on the importance of careful patient selection, meticulous stent implantation, and consistent use of medications to prevent the delayed formation of blood clots that can block blood flow to the heart, a condition known as late stent thrombosis.

"Practicing physicians and their patients are naturally concerned by the recent finding of a very small, but important risk of very late stent thrombosis. Since SCAI's membership includes the vast majority of practicing interventional cardiologists, we felt it was critical to give some practical advice and guidance in an attempt to ensure optimal outcomes for our patients with coronary artery disease. Coronary artery disease is still the number one cause of death in the Western world, and anything we can do to maximize therapy while minimizing risk is welcome." said John McB. Hodgson, M.D., FSCAI, the lead author of the clinical alert, a Past President of SCAI, and Chief of Academic Cardiology at St. Joseph's Hospital and Medical Center in Phoenix, AZ.

Drug-eluting stents are mesh tubes that prop open narrowed arteries in the heart while slowly releasing a medication that prevents the build-up of scar tissue inside the stent. These tiny devices have been very successful in preventing renarrowing, or restenosis, of the coronary arteries, reducing the rate of this complication by 40--60 percent compared to their bare metal counterparts. However, several recent analyses that tracked patient outcomes for four to five years after stent placement showed that blood clots were slightly more likely to form inside a drug-eluting stent than inside a bare metal stent. It is not yet clear how large the difference in risk is, but available data suggest that in the types of lesions treated in the original controlled trials it is about 0.2% excess (compared to bare metal stents) per year after year one. When this occurs, the patient may suffer a heart attack or even die.

"Given this new information, treatment decisions hinge on assessing the balance between the risk of restenosis and risk of late stent thrombosis," Dr. Hodgson said. "It is important for the clinician to consider the risk--benefit ratio for each individual patient. Interventionalists are encouraged to involve patients, whenever possible, in these discussions."

This clinical alert has been designed to provide interventional cardiologists with practical advice on how to evaluate and minimize the risk of late stent thrombosis. Its recommendations include the following:

  • Prior to any stent implantation, patients should meet accepted criteria for coronary intervention as described in guidelines jointly published by the ACC, AHA, and SCAI.
  • The decision to treat a patient with a drug-eluting stent--rather than a bare metal stent or bypass surgery--must be made on an individual patient basis, considering the relative risks and benefits of each therapy. This determination will vary according to each patient's medical history, coexisting illnesses, and lesion characteristics.
  • Patients must be carefully evaluated for their ability to adhere to long-term therapy with dual anti-clotting medications.
  • Careful attention must be paid to stent implantation technique, including the use of intravascular ultrasound, screening for arterial calcification, and pretreatment of complex lesions in some cases.
  • Patients should take dual anti-clotting medication for at least three to six months, preferably for 12 months unless there is a high risk for bleeding. In patients with a higher-than-average risk for late stent thrombosis--for example, those with diabetes--physicians should consider not only continuing dual anti-clotting medication for longer than 12 months, but also testing responsiveness to these medications and adjusting dosages as needed.
  • Discontinuation of dual anti-clotting medication requires careful consideration and must be individualized for each patient.

Several large multicenter trials to better define the risk of late stent thrombosis and assess strategies to prevent this complication are in progress or will soon begin enrolling patients. In the meantime, drug-eluting stents remain an important treatment option for many patients.

"Patients should be reassured that the implantation of a drug-eluting stent, after careful consideration with their physician, remains a very effective method for the treatment for symptoms associated with the disabling problem of coronary artery disease," Dr. Hodgson said.

About SCAI

Headquartered in Washington, DC, the Society for Cardiovascular Angiography and Interventions is a 3,700-member professional organization representing invasive and interventional cardiologists in seventy nations. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty. SCAI's next annual meeting will be in Orlando, FL, May 9--12, 2007.


Story Source:

The above story is based on materials provided by Society for Cardiovascular Angiography and Interventions. Note: Materials may be edited for content and length.


Cite This Page:

Society for Cardiovascular Angiography and Interventions. "Clinical Alert On Drug-eluting Stents And Late Thrombosis." ScienceDaily. ScienceDaily, 11 January 2007. <www.sciencedaily.com/releases/2007/01/070111092903.htm>.
Society for Cardiovascular Angiography and Interventions. (2007, January 11). Clinical Alert On Drug-eluting Stents And Late Thrombosis. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2007/01/070111092903.htm
Society for Cardiovascular Angiography and Interventions. "Clinical Alert On Drug-eluting Stents And Late Thrombosis." ScienceDaily. www.sciencedaily.com/releases/2007/01/070111092903.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

House Republicans Vote to Sue Obama Over Healthcare Law

House Republicans Vote to Sue Obama Over Healthcare Law

Reuters - US Online Video (July 31, 2014) The Republican-led House of Representatives votes to sue President Obama, accusing him of overstepping his executive authority in making changes to the Affordable Care Act. Mana Rabiee reports. Video provided by Reuters
Powered by NewsLook.com
Despite Health Questions, E-Cigs Are Beneficial: Study

Despite Health Questions, E-Cigs Are Beneficial: Study

Newsy (July 31, 2014) Citing 81 previous studies, new research out of London suggests the benefits of smoking e-cigarettes instead of regular ones outweighs the risks. Video provided by Newsy
Powered by NewsLook.com
Dangerous Bacteria Kills One in Florida

Dangerous Bacteria Kills One in Florida

AP (July 31, 2014) Sarasota County, Florida health officials have issued a warning against eating raw oysters and exposing open wounds to coastal and inland waters after a dangerous bacteria killed one person and made another sick. (July 31) Video provided by AP
Powered by NewsLook.com
Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins