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American Heart Association/American College of Cardiology/Society for Cardiovascular Angiography and Interventions Joint Scientific Statement
Date:12/13/2007

e artery and prevent re-blocking.

In the past several years, drug-coated -- also called drug-eluting -- stents have been used. The drug on the stent helps even more to prevent the artery from becoming blocked again. However, these coated stents have a slightly higher risk of clots forming inside them, so patients who receive them must take a combination of anti-clotting medicines for a year or longer after their procedure.

Because of the higher risk of in-stent clotting, the guideline writing committee emphasizes the importance of dual antiplatelet therapy after drug-eluting stents (DES). This requirement increases the patient's responsibility in treatment to ensure successful stenting.

The guideline writing group recommended that a DES should be considered as an alternative to a bare-metal stent in those patients for whom clinical trials indicate a favorable effectiveness and safety profile, but emphasized that it's very important before performing the procedure to be sure that after receiving the DES the patient can comply with the dual antiplatelet therapy of aspirin and clopidogrel.

The guidelines state that at least one year of clopidogrel therapy is required and possibly a longer administration may be considered in patients undergoing DES placement. Thus, "before implanting a drug-eluting stent, the interventional cardiologist should discuss with the patient the need for and the duration of dual antiplatelet therapy (clopidogrel plus aspirin) and confirm the patient's ability to comply with the recommended therapy." Members of the writing group emphasized that it is important that patients be actively involved in the decision, because their participation is necessary for successful treatment.

Continuing dual antiplatelet therapy is so important that the guidelines take into consideration future medical procedures that may require the therapy to be interrupted. If patients face additional surgery, recommendations cal
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SOURCE American Heart Association
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