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Updated: Aug 8, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
[Thrombosis of a coronary stent after discontinuing treatment with clopidogrel]
J W van Werkum1, A A C M Heestermans, W Jaarsma
1St Antonius Ziekenhuis, afd Cardiologie, Nieuwegein.
Insights
Discontinuing clopidogrel after drug-eluting stent implantation can lead to stent thrombosis and myocardial damage. Maintaining dual antiplatelet therapy with aspirin and clopidogrel is crucial for preventing complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Drug-eluting stents are commonly used to treat coronary artery disease.
- Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is standard after stent implantation.
- Discontinuation of DAPT, especially premature cessation, poses a risk for stent-related complications.
Observation:
- Four patients (67M, 42F, 41F, 41M) with acute myocardial infarction or angina received drug-eluting stents.
- All four patients experienced stent thrombosis after discontinuing clopidogrel therapy, often prematurely.
- Reasons for discontinuation included allergic reactions, dental procedures, and insurance issues.
Findings:
- Stent thrombosis occurred within weeks of clopidogrel cessation in these cases.
- Percutaneous coronary intervention to restore patency resulted in irreversible myocardial damage for all patients.
- The study highlights a critical link between clopidogrel discontinuation and adverse cardiovascular events post-stenting.
Implications:
- Reinforces the necessity of combination therapy with acetylsalicylic acid and clopidogrel during and after angioplasty.
- Emphasizes the importance of patient and physician awareness regarding the risks of early antiplatelet therapy discontinuation.
- Suggests improved patient education and communication strategies are needed to ensure adherence to DAPT regimens.
Abstract:
A drug-eluting stent was implanted in four patients, a man aged 67 and a woman aged 42 with acute myocardial infarction, a woman aged 41 with unstable angina pectoris and a man aged 41 with stable angina pectoris. All suffered stent thrombosis after discontinuation (in three cases prematurely) of clopidogrel therapy. Reasons for discontinuation included allergic reaction, a dental procedure and refusal of reimbursement by the insurer. In order to restore stent patency they were treated by percutaneous coronary intervention and all patients suffered irreversible myocardial damage. Combination therapy using acetylsalicylic acid and clopidogrel during and after angioplasty for the prevention of long- and short-term complications is necessary. Stent thrombosis after drug-eluting stent implantation usually occurs within 1-4 weeks following discontinuation ofantiplatelet medication. These cases stress the importance of antiplatelet therapy after stent implantation. Physicians, dentists and patients must be aware of the risk of the early discontinuation ofantiplatelet therapy.
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