Harvard Heart Letter

Blood clots a late hazard for drug-coated stents

The benefits of drug-coated stents come with a price — long-term use of clot-preventing drugs.

When the first drug-coated stent earned FDA approval in 2003, it was hailed as a revolution in treating cholesterol-clogged arteries. These tiny, drug-releasing cages solved a problem linked with their bare-metal precursors: a vexing renarrowing of the artery. But their wide use is showing that they can create problems of their own. One that's gaining attention is the sudden appearance of blood clots that can completely block a stent months after implantation, often causing a heart attack or sudden cardiac arrest.

This problem, called late stent thrombosis, isn't common. It affects up to 3 people in 100 who get a drug-coated stent, sometimes a year or two later. Faithfully taking aspirin and clopidogrel (Plavix) is a key strategy for keeping clots at bay. But what happens if you aren't good at taking medications, or if circumstances beyond your control — like needing surgery or having a serious stomach bug — make it difficult or impossible to take these drugs? How long must you take them after getting a stent? And if you don't have a stent but some day need one, should it be a bare-metal type?

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