Heart stents may require longer blood thinner use

[Omaha Steve]

Source: AP-Excite

By MARILYNN MARCHIONE

CHICAGO (AP) — Millions of people with stents that prop open clogged heart arteries may need anti-clotting drugs much longer than the one year doctors recommend now. A large study found that continuing for another 18 months lowers the risk of heart attacks, clots and other problems.

Even quitting after 30 months made a heart attack more likely, raising a question of when it's ever safe to stop. It's a big issue because the drugs can be expensive and bring risks of their own. The result also is a surprise, because the trend has been toward shorter treatment, especially in Europe.

"It's a wake-up call. It's the opposite of where we've been going," said Dr. Patrick O'Gara, clinical cardiology chief at Brigham and Women's Hospital in Boston and president of the American College of Cardiology.

He had no role in the study, which was led by Brigham's Dr. Laura Mauri, at the request of the federal Food and Drug Administration. Results were discussed Sunday at an American Heart Association conference in Chicago and published online by the New England Journal of Medicine.

FULL story at link.



FILE- This undated image provided by Boston Scientific shows the drug-coated Taxus Express Paclitaxel Eluding Coronary Stent System. A major study answers a key question facing hundreds of thousands of people each year who get heart stents to prop open clogged arteries. (AP Photo/Boston Scientific, File)


Read more: http://apnews.excite.com/article/20141116/us-med--heart_stents-e279f3c6ec.html

[Warpy]

1. At least now there are a few blood thinners

that don't require the close monitoring of warfarin. Unfortunately, they're on patent, so they're expensive for people who don't have medication insurance.

I always wondered if maintaining post stent patients on aspirin, alone, was a wise idea. Too many of them were coming back to us with clots just before or just after the stent.

[Brigid]

2. I take clopedigrel and low-dose aspirin.

I had triple bypass surgery almost seven years ago. No stents.

[Warpy]

4. Women generally have poorer outcomes from bypasses and stenting

so long term anticoagulation looks like the best plan in women after any cardiac intervention.

There are far worse medications to be on.

[Brigid]

5. I am doing far better than I have any right to be doing.

I almost didn't see my 50th birthday later that year.

[hue]

11. I agree. Taking Plavix & low dose aspirin is very protective. If You have any chest pain or shortnes

of breath or symptoms similar to Your previous event go to the ER immediately and You most likely can have stents placed in a 1 hr procedure even tho You had bypass years ago.

[Liberal Veteran]

3. I took Effient after stent placement because it had less interaction with my other meds.

I take beta blockers, ace inhibitors, antivirals, statins, an ssri and I gotta say that 18 months I took Effient was pretty bad. Dizziness was my new best friend. I was pleasantly surprised at how quickly that resolved after I stopped taking it. I'm really glad I wasn't put on rat poison though. Warfarin just seems like a big hassle.

[kwassa]

6. oh well, I survived.

been several years since I stopped using Plavix.

[hue]

9. If You don't take EC low dose aspirin You should start now. It really helps in case You have another

"event". Low dose aspirin is good in many ways including reducing the risk of colon cancer.

[kwassa]

13. oh, I do, and a low-dose betablocker.

All my numbers are fine, too. I've never had high blood pressure.

[HeiressofBickworth]

7. I had angioplasty and a stent in 2000

The stent is metal but not drug-coated. I was on Plavix for about 18 months after that and I continue with a low-dose aspirin. For the first 10 years, I saw the cardiologist every six months. For the past three years, I see him once a year. So far, no problems. I always read articles like this, but since it's been so long since the event (no actual heart attack), I'm less and less concerned. I have other pressing health issues that are more likely to cause problems in the short term.

[WheelWalker]

8. My intuition told me this after my coronary in May, 2003...

I had coated stents implanted into my left main only a week or so after they were approved by the FDA. The docs wanted to wean me off the extended release nitrate (Imdur Mono) and the clopidigrel (Plavix) after 4 mos. post-infarct. I told them "no thanks, I'm doing just fine as I am. I'll just keep taking these meds if you don't mind". And today, I still take all the meds I checked out of hospital with those many years ago. Call me crazy, and maybe I am.

[hue]

10. You def made the correct choice. Studies show extended protection is best.

It's not crazy to want to live and even if You were crazy at least You're alive & crazy. Besides, if You don't go crazy once in awhile You'll go crazy...

[eggplant]

12. I went nearly seven years before dropping Plavix.

I'm glad I dropped it -- the combo of that and aspirin made me bleed at the drop of a hat. I still see my cardiologist regularly, of course, but I'm 8 years post-event and seem to be doing ok.

I'd say that the best thing for my outcome was the six months of intense cardio rehab I did post-event, along with long term lifestyle changes.

[The Jungle 1]

14. What to do

I had a stent installed this spring. I haven't felt this good in a long time. It is a very strange instant cure. Suddenly I could do many things that I was unable to do before. I can run again. I am doing 2 miles several times a week and it feels great.

I was on Warfarin before the stent and will be on it the rest of my life. I try and look at the bright side. Lower stroke risk and lower general clotting. The biggest problem with Warfarin was the constant blood tests. They now have a home monitor and it works great.