Harvard Heart Letter

Heart Beat: Clots can form in stents years after placement

Wire-mesh stents were invented to prop open heart arteries that balloon angioplasty had just cleared of cholesterol-laden plaque. Coating them with drugs helped fix an early problem: cells from the artery wall surrounding the stent sometimes grew over and around the stent and clogged the space through which blood flows.

But without a protective coating of artery-wall cells, a stent is an attractive surface for blood-clot formation. If such a clot is large enough, it can trigger a heart attack. This is called stent thrombosis.

The solution for this problem is to take two drugs that block clot formation for at least one year after getting a drug-coated stent. One of those drugs is aspirin. The second is usually clopidogrel (Plavix), but doctors sometimes prescribe prasugrel (Effient) or ticagrelor (Brilinta) as the second.

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