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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
A current problem in cardiology: very late thrombosis after implantation of sirolimus eluting stent
Mohammad Bagher Sharifkazemi1, Mahmood Zamirian, Amir Aslani
1Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, Iran. draslani@yahoo.com
Insights
Discontinuing antiplatelet drugs after coronary stenting increases thrombosis risk. This case shows very late stent thrombosis 24 months post-implantation, even with aspirin, suggesting longer dual antiplatelet therapy is needed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Antiplatelet therapy is crucial after coronary stent implantation to prevent thrombosis.
- Standard protocols often involve dual antiplatelet therapy (DAPT) for a defined period.
- Early stent thrombosis typically occurs within weeks of implantation.
Observation:
- A rare case of very late stent thrombosis (VLST) is presented.
- This occurred 24 months after sirolimus-eluting stent implantation.
- The patient had discontinued clopidogrel 18 months prior but continued aspirin.
Findings:
- Very late stent thrombosis can occur significantly later than previously reported.
- VLST occurred despite single antiplatelet therapy with aspirin.
- This challenges current assumptions about the duration of DAPT post-stenting.
Implications:
- Prolonging dual antiplatelet therapy, including clopidogrel, may be warranted in select patients.
- Further randomized trials are needed to establish optimal DAPT duration.
- This case highlights the importance of considering individual patient risk for VLST.
Abstract:
Discontinuation of antiplatelet medications has been strongly associated with coronary stent thrombosis. The first reported cases have been documented at 6 h to 6 weeks after stent implantation. This article presents a case of very late stent thrombosis 24 months after sirolimus eluting stent implantation and 18 months after clopidogrel discontinuation, despite aspirin continuation, and argues in favor of prolonging dual antiplatelet medication including clopidogrel in this setting, at least until data from randomized trials address this important issue.