Stent recipients may require longer use of anti-clotting drugs
CHICAGO — Millions of people with stents that prop open clogged arteries may need anti-clotting drugs much longer than the one year doctors recommend now. A large study found that continuing for 18 more months lowers the risk of heart attacks, clots and other problems.
Even quitting after 30 months made a heart attack more likely, raising a question of when it’s ever safe to stop. It’s a big issue, because the drugs can be expensive and bring risks of their own. The result also is a surprise, because the trend has been toward shorter treatment, especially in Europe.
“It’s a wake-up call. It’s the opposite of where we’ve been going,” said Dr. Patrick O’Gara, clinical cardiology chief at Brigham and Women’s Hospital in Boston and president of the American College of Cardiology.
He had no role in the study, which was led by Brigham’s Dr. Laura Mauri, at the request of the federal Food and Drug Administration. Results were discussed Sunday at an American Heart Association conference in Chicago and published online by the New England Journal of Medicine.
The FDA says it is studying the results and that doctors should not change practice yet.
The study concerns care after angioplasty, a procedure done on millions of people worldwide each year. Through a blood vessel in the groin or an arm, doctors push a tube to the clog, inflate a tiny balloon to flatten it, and place a mesh tube called a stent to keep the artery open.
Early bare-metal stents didn’t work well — arteries tended to reclog quickly. Coated ones that ooze drugs to prevent that problem came out a decade ago but have their own drawback: a small risk of clots that occur months later, a serious type that often cause heart attacks and can kill.
To prevent that, people with drug-coated stents are told to take aspirin and a second type of anti-clotting drug for a year. But no one really knows how long the second drug is needed.
The study involved nearly 10,000 people who took aspirin plus either Plavix or Effient for one year after getting a drug-coated stent. All stayed on aspirin for 18 more months, and half stayed on Plavix or Effient, too.