Early reports of thrombosis after insertion of drug-elut...( This release is also available in

Authors of a research letter in this week's issue of THE LANCET highlight how the use of drug-eluting stents (DES) may carry a risk of subsequent thrombosis if stenting is accompanied by a withdrawal of antiplatelet therapy.

More than 1.5 million people a year have stents implanted to improve coronary artery blood flow. A recently published pooled analysis of 11 trials (see Lancet 2004; 364: 583-91) suggested that DES--increasingly used in coronary angioplasty--have benefits over bare-metal stents (BMS) by reducing the need for later revascularisation and reducing the risk of cardiac events.

Patrick W Serruys (Erasmus Medical Center, Netherlands) and colleagues report four cases of angiographically-confirmed stent thrombosis that occurred around a year after elective implantation of polymer-based paxlitaxel-eluting or sirolimus-eluting stents; all four cases resulted in myocardial infarction (heart attack). All cases arose soon after antiplatelet therapy was interrupted.

Professor Serruys comments: "We report these cases to draw attention to a problem, with serious clinical implications, that might be under-reported. We suggest that the potential risk of stent occlusion should be considered when discontinuation of antiplatelet therapy is contemplated in patients with drug-eluting stents. As the use of drug-eluting stents becomes widespread, careful long-term follow-up of patients with such stents is needed to assess the true rate of late thrombosis."

In an accompanying commentary (p 1466), Mark J Eisenberg (Jewish General Hospital/McGill University, Montreal, Canada) concludes: "drug-eluting stents are so new that many health-care professionals are not aware of the critical need for prolonged and continuous antiplatelet therapy. Therefore, both patients and physicians should be sensitised to the possibi
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
21-Oct-2004