Relative Risk For Blood Clot In Patients With Drug-Eluting Stents. There is as much as a four- to five- fold increased relative risk for late thrombosis, or blood clot formation, in patients with drug-eluting stents compared to those with bare-metal stents, according to a Cleveland Clinic-led meta-analysis published in the December issue of the American Journal of Medicine. This is the first published analysis of its kind.
Drug-eluting and bare-metal stents are commonly used to treat patients with coronary artery disease. There has been a growing body of evidence that drug-eluding stents, when compared to bare-metal stents, may increase the risk of blood clot formation long after they are implanted, potentially triggering a heart attack.
“Our analysis found there is a small, but real, hazard of late stent thrombosis with drug-eluting stents more so than with bare-metal stents, likely in the setting of discontinuation of anti-clotting drugs,” said Deepak L. Bhatt, M.D., Associate Director of the Cleveland Clinic Cardiovascular Coordinating Center and one of the study’s authors. “This does not, however, mean that drug-eluting stents should not be used, as other studies have shown that they do significantly reduce the need for repeat procedures compared with bare-metal stents.”
Fourteen studies with 6,675 total patients were included in the analysis comprising nine sirolimus stent trials and five paclitaxel stent trials. Eight of the trials reported more than a year of clinical follow-up. The sirolimus trials mandated anti-clotting medication for at least two to three months and the paclitaxel trials required six months.
“The key to the controversy is likely careful patient selection,” Dr. Bhatt said. “Further research is needed to determine how best to utilize drug- eluting stents and anti-clotting medications.”
FDA Will Discuss Issues Related To Stent Thrombosis
This analysis precedes an FDA Advisory Panel set to meet next week in Washington, D.C. The committee will discuss and make recommendations regarding issues related to stent thrombosis in coronary drug-eluting stents.
Cleveland Clinic Heart & Vascular Institute is the recognized world leader in diagnosis and treatment of cardiovascular disease. Cleveland Clinic has been ranked No. 1 in the nation for cardiac care by U.S. News & World Report every year since 1995. Cleveland Clinic has been ranked among America’s Ten Best Hospitals every year since 1990 by U.S. News & World Report.
Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Approximately 1,500 full-time salaried physicians at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2005, there were 2.9 million outpatient visits to Cleveland Clinic. Patients came for treatment from every state and from more than 80 countries. There were nearly 54,000 hospital admissions to Cleveland Clinic in 2005. Cleveland Clinic’s Web site address is www.clevelandclinic.org.