Antiplatelet therapy in the era of late stent thrombosis

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Drug-eluting stents (DES) are a primary treatment for obstructive coronary artery disease via percutaneous intervention.
• Concerns exist regarding stent thrombosis, myocardial infarction, and death with DES, but large trials show low overall risk for both DES and bare metal stents (BMS).
• Late stent thrombosis appears more frequent with DES and is strongly associated with dual antiplatelet therapy (DAPT) discontinuation.

Purpose of the Study:

• To evaluate the risks associated with drug-eluting stents (DES) in coronary artery disease treatment.
• To highlight the critical role of dual antiplatelet therapy (DAPT) adherence in preventing late stent thrombosis after DES implantation.
• To provide guidance for interventional cardiologists regarding patient selection and management to mitigate DES-related risks.

Main Methods:

• Analysis of large randomized trials comparing DES and bare metal stents (BMS).
• Review of data on stent thrombosis incidence and timing in relation to antiplatelet therapy.
• Assessment of factors influencing late stent thrombosis, particularly DAPT discontinuation.

Main Results:

• The overall risk of stent thrombosis with both DES and BMS is small.
• Late stent thrombosis occurs more frequently with DES.
• Late stent thrombosis is closely associated with premature discontinuation of DAPT (aspirin and a thienopyridine).

Conclusions:

• Interventional cardiologists must ensure patients can adhere to DAPT for at least one year post-DES implantation.
• If DAPT discontinuation is anticipated, consider BMS or bypass surgery.
• Consult cardiology and follow guidelines if DAPT interruption is necessary due to unforeseen circumstances like surgery.