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Published on: August 26, 2025
[Antithrombotic therapy after percutanous coronary intervention with stenting]
Harald Vik-Mo1, Morten Slette, Knut Hegbom
1Hjertemedisinsk avdeling, St. Olavs Hospital, 7006 Trondheim. harald.vik-mo@ntnu.no
Insights
Preventing stent thrombosis requires careful management of antiplatelet therapy. Discontinuation of aspirin and clopidogrel, especially before non-cardiac surgery, increases risks. Optimal timing and medication choices are crucial for patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Surgery
Background:
- Stent thrombosis is a serious complication with high mortality.
- Inadequate platelet inhibition is a potential cause of stent thrombosis.
- This review examines long-term antiplatelet treatment effects in patients with coronary stents.
Purpose of the Study:
- To review the management of antiplatelet therapy in patients with coronary stents.
- To identify factors contributing to stent thrombosis.
- To provide guidance on perioperative management and antithrombotic medication.
Main Methods:
- Literature review using Pubmed.
- Analysis of clinical experience.
Main Results:
- Stent thrombosis is linked to premature discontinuation of acetylsalicylic acid and/or clopidogrel.
- Non-cardiac surgery soon after stenting increases stent thrombosis risk.
- Recommendations include delaying non-cardiac surgery (6 weeks for bare metal stents, 6 months for drug-eluting stents) or performing it without drug discontinuation if possible.
- For patients requiring anticoagulation, bare metal stents are preferred, with warfarin, acetylsalicylic acid, and clopidogrel as antithrombotic therapy.
Conclusions:
- Adequate patient, physician, and pharmacy education on antithrombotic drug use is vital.
- Proper medication management can help avoid stent thrombosis and acute myocardial infarction.
Background:
Patients with stent thrombosis have a serious prognosis and a high mortality. Insufficient blood platelet inhibition may be the cause of the condition. This article reviews patients--with stents in their coronary arteries--that have had documented effects of long-term blood platelet treatment.
Material And Methods:
The article is based on literature identified through a Pubmed search and own experience.
Results:
Premature discontinuation of acetylsalicylic acid and/or clopidogrel, and non-cardiac surgery shortly after stenting are commonly associated with stent thrombosis. Elective non-cardiac surgery should be done without discontinuation of blood platelet inhibitors when possible. It should be delayed for a minimum of 6 weeks after implantation of bare metal stents and for a minimum of 6 months after drug-eluting stents. For patients who need anticoagulation bare metal stents are preferred, and a combination of warfarin, acetylsalicylic acid and clopidogrel should be used as antithrombotic medication.
Conclusion:
It is important to provide adequate information about correct antithrombotic drug use to patients, physicians and pharmacies in order to avoid stent thrombosis and acute myocardial infarction.
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