Drug-Eluting StentWords

--Drug-Eluting Stent Controversy: No Clear-Cut Answer--

Drug-eluting stents, called by some the biggest breakthrough for interventional cardiology in 25 years, have been the source of recent controversy. These devices appear to pose a higher risk of blood clots, which can lead to heart attacks, than conventional bare-metal stents. An FDA panel convened last week in Gaithersburg, Maryland, to evaluate this risk.

Drug-eluting stents ooze medicine that prevents arteries from growing scar tissue and ultimately, from renarrowing--a problem commonly associated with conventional stents. When drug-eluting stents hit the market in 2003, they were highly endorsed by cardiologists and have been widely used ever since, inhabiting the arteries of 3 million Americans.

Now, it seems these drug-spewing stents are more likely to cause blood clots--a risk considered more severe than the renarrowing associated with stents of old. This risk can be minimized, however, when patients remain on anti-clotting medications, like Plavix and aspirin. But this medication is very expensive and induces bleeding during prolonged use.

And there is yet another problem associated with drug-eluting stents; patients who have them and later undergo surgery must be taken off of their anti-clotting medication so as to minimize chances of perioperative bleeding. But discontinuing anti-clotting medication invites risk of late stent thrombosis (clotting).

Thus, the trade-off: patients with drug-eluting stents who undergo surgery can either stay on their anti-clotting meds and endure complications associated with bleeding, or discontiue them entirely, risking clot formation that could lead to heart attacks.

I'm speaking with cardiologists across the nation, and anasthesiologists, too, to see how they will resolve the issue of drug-eluting stent safety. More to come. And it will start with George Vetrovec in Virginia.

.MGW.