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Page: << Prev | 1 | 2 But the study also showed a marked reduction in the need for repeat angioplasties among patients getting drug-eluting stents -- one in 12, compared to one in five for those getting bare-metal stents.
The immediate issue concerns the use of Plavix for such patients, cardiologists said. "The amount of your benefit hinges on the ability of patients to take clopidogrel long-term," Kong said.
"This [the Swiss] study definitely raises the question of whether these drug-eluting stents should be anti-coagulated for a long period of time," said Dr. John Kao, an assistant professor of medicine at the University of Illinois at Chicago. "What that time period is, is, at this moment, unclear."
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Drug-eluting stents now dominate the market, accounting for 80 percent to 90 percent of implants. That situation should continue, said Dr. Robert O. Bonow, director of cardiology at Northwestern University and a spokesman for the American Heart Association, because "they are very effective at preventing restenosis [closure of the artery]."
But in doing so, the drug-eluting stents may also prevent the regrowth of the normal tissue that lines the artery, increasing the risk of thrombosis, Bonow said. Plavix can counter that risk, he said.
"Until we know more, any cardiologist would recommend continued use of clopidogrel," Bonow said. "The uncertainty is how long we keep people on Plavix, indefinitely or for the first two years."
There might be a subset of angioplasty patients for whom bare-metal stents are preferable, Bonow said, such as "patients who have more simple plaques [deposits] in large blood vessels." But drug-eluting stents are preferable in most cases, he added.
Money might enter into the decision as to which stent to use, Kao said. Plavix therapy costs at least $120 a month, he said, and, "at least in my practice, when I evaluate someone who needs intervention, if the patient is on a fixed income and cannot afford to take Plavix for six to 12 months, I put in a bare-metal stent."
Kao's recommendation for Plavix use by people who get drug-eluting stents is "at least a year, indefinitely if they can afford it."
People faced with angioplasty should be aware of "the upside and downside of a drug-eluting stent," Bonow said. "With Plavix, it usually is a risk worth taking."
More information
For more on stents, visit the American Heart Association (www.americanheart.org ).
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