Anticlotting drugs urged with use of some stents

DALLAS -- Heart patients who had drug-coated stents inserted to prop open blocked coronary arteries should stay on anti clotting drugs for at least a year, several doctor groups said in an advisory issued yesterday.

The advisory recommends that doctors tell their patients to take an anti clotting drug such as Plavix and aspirin for a year to reduce the risk of clotting, which could lead to a heart attack or death. The long-term safety of Plavix in stent patients has not been established.

Drug-coated stents are often chosen over bare-metal stents because they slowly release medication that reduces the chance of arteries reclogging, which can mean follow-up surgery. The newer stents, however, mean a small but significantly higher clot risk.

The new advisory cited research showing blood clots in up to 29 percent of patients who stopped anti-clotting drugs early after receiving a drug-coated stent. The doctors also cited a study of 500 patients who received the drug-coated stents after a heart attack in which the death rate over the next 11 months was 7.5 percent for those who stopped taking anticlotting medication compared with 0.7 percent for those who continued the regimen.

The advisory will lead to more dialogue between patients and doctors, said Dr. Cindy Grines, chairwoman of the advisory writing committee.

The new information means that before stent surgery, doctors must discuss with patients whether there's any reason they might not be able to keep up the drug regimen for at least a year, said Dr. John Warner, medical director of the heart, lung, and vascular center at the University of Texas Southwestern Medical Center. If the cost of the drug -- Plavix is $4 a day -- or an upcoming surgery would require stopping the drug, he said it might be best to use a bare-metal stent.