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Stopping medication too soon after receiving a drug-eluting stent raises risk of death

Heart attack patients who stopped taking antiplatelet drugs (which help prevent blood clots) within 30 days of receiving a drug-coated stent had nine times the risk of death compared to patients who followed doctors' orders, according to a study reported in Circulation: Journal of the American Heart Association.

"An alarming one in seven patients in our study stopped taking their antiplatelet medication within the first 30 days of receiving a drug-eluting stent (DES), even though they were prescribed the drugs at the time of hospital discharge and recommendations are to continue them for a minimum of three to six months after the procedure," said John A. Spertus, M.D., M.P.H., lead author of the study and director of cardiovascular education and outcomes research at the Mid America Heart Institute in Kansas City, Mo.

Researchers looked at the real-world use of DES in heart attack patients and a class of drugs called thienopyridines that work along with aspirin to help keep platelets in the blood from clumping and leading to the formation of blood clots. Thienopyridines include the drugs clopidogrel and ticlopidine. Blood clots can obstruct a coronary artery, causing a heart attack.

Several studies have confirmed the benefits of DES in preventing restenosis (reclosing of the artery that had been treated). However, with stents there is the potential problem of stent thrombosis (blood clots forming inside the stent), which can be associated with devastating consequences. Antiplatelet agents, including thienopyridines, reduce the likelihood of stent thrombosis. According to Spertus, no previous studies have defined the frequency and consequences of prematurely discontinuing thienopyridine therapy.

The risk of stent thrombosis with bare-metal stents (stents not coated with a drug) decreases rapidly after two to four weeks, and patients typically need thienopyridines for only about one month. In comparison, with drug-eluting stents th
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Contact: Bridgette McNeill
bridgette.mcneill@heart.org
214-706-1396
American Heart Association
12-Jun-2006


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