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Nov 20, 2014

Risks and Benefits of Extending Drug Treatment After Stent

Lengthening anti-clotting treatment after stent implantation may prevent heart attacks but increases risk of bleeding, finds new study.

Lengthening anti-clotting treatment after stent implantation may prevent heart attacks but increases risk of bleeding, according to a study presented on Nov. 16 at the American Heart Association 2014 Scientific Sessions. 

Each year, millions of patients with heart disease have stents implanted to treat narrow or weak arteries and promote healthy blood flow. Although stents reduce risk of serious conditions like heart attack, these small mesh tubes increase risk of clotting, which is why experts developed drug-eluting stents that contain anti-clotting medication to reduce risk of complications. But even with a drug-eluting stent, it’s recommended that patients take aspirin and a prescription anti-clotting drug after stent implantation. The question is—how long should patients continue to take both medications to reduce risk of complications? 

Through the Dual Antiplatelet Therapy Study, researchers compared 12 vs. 30 months of aggressive anti-clotting therapy after stenting. Almost 10,000 patients participated in the study and were randomly assigned to take either 12 or 30 months of aspirin plus a prescription anti-clotting drug (clopidogrel (brand: Plavix) or prasugrel (brand: Effient)), after which time they took aspirin, alone. 

Following analysis, researchers found that extending the use of aspirin plus prescription anti-clotting drugs to 30 months significantly reduced risks of clots and major heart events, like heart attack, compared to just a year of use. However, taking the more aggressive treatment beyond a year increased risk of bleeding—one of the most common complications associated with anti-clotting meds. 

Based on these findings, it’s clear that extending aggressive anti-clotting treatment carries both risks and benefits. Although such treatment significantly reduced risk of heart events, it carried an increased bleeding risk compared to shorter-term therapy. Therefore, it’s important that patients with or receiving stents discuss treatment options with their doctor to determine the length and type of treatment that works best for them.

Questions for You to Consider

  • How do drug-eluting stents differ from other types of stents?

  • The two main types of stents—bare-metal stents and drug-eluting stents—perform the same function of keeping the artery open and preventing it from collapsing. However, drug-eluting stents have the added function of preventing clots and tissue from forming around the stent by releasing medication.
  • What are the most common risks associated with drug-eluting stents?

  • Although drug-eluting stents are generally safe and effective, the most common complications include blood clotting around the stent and re-narrowing of the arteries, called restenosis.


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Resources to Help You Compare Treatment Options

Guidance from the Agency for Healthcare Research and Quality (AHRQ) in making health decisions