How Long Should You Take Anti-Clotting Medications After Getting a Stent?
If you have a stent in a coronary artery, a study recently reported in the New England Journal of Medicine has some important results to discuss with your doctor.
It has been common practice for patients who have had a stent placed to clear a blocked artery to take an anti-clotting drug (such as Plavix, Effient, or Brilinta) plus aspirin for 12 months after the procedure. Taking these two medications, called dual anti-platelet therapy, reduces the risk of forming blood clots. However, the optimal length of time to remain on the therapy is unknown.
The recently released study involving 9,961 patients found that stent patients taking dual anti-platelet therapy for 30 months were less likely to develop blood clots on the stent (stent thrombosis) or experience a heart attack when compared to those patients who took dual anti-platelet therapy for 12 months followed by aspirin alone for the remaining 18 months. Specifically:
- The rate of heart attacks in the 30-month group was 2.1 percent compared with 4.1 percent in the 12-month group.
- The rate of blood clots forming in the stent (stent thrombosis) was 0.4 percent among patients taking dual anti-platelet therapy for 30 months compared with 1.4 percent among patients taking dual anti-platelet therapy for 12 months.
- Surprisingly, there was an increase in the rate of death from any cause in the 30-month group compared to the 12-month group (2.0% vs. 1.5%).
Risks to Consider
Despite the benefits shown by the study, patients in the longer medication group had a significantly higher rate of moderate to severe bleeding—2.5 percent compared with 1.6 percent. Bleeding is always a serious risk with anti-clotting medications. Once the patients in the 30-month group stopped taking the drugs, their rate of heart attacks increased, suggesting that some people may need indefinite therapy.
The Bottom Line
The goal in prescribing anti-platelet therapy is to give you the greatest protection against future heart attacks and blood clots while minimizing the risk of bleeding. Extended therapy is a decision that needs to be individualized in discussion with your doctor, who will talk with you about factors like your risk of recurrent cardiovascular events and bleeding.
Rupal P. Dumasia, MD
Rupal P. Dumasia, MD, FACC, FSCAI, is an interventional cardiologist with The Heart Group of Lancaster General Health and director of the catheterization lab at LG Health.
Education: A graduate of the New Jersey Medical School, Dr. Dumasia completed his residency at the Hospital of the University of Pennsylvania and fellowship at the University of Michigan Medical Center. His areas of expertise include angioplasty and stent placement, transcatheter aortic valve replacement, and cardiac catheterization.