The post-procedural management of patients with coronary stents is focussed on prevention of stent thrombosis and secondary prevention of the underlying vascular disease. The risk of stent thrombosis is minimised by treatment with the combination of aspirin and clopidogrel ('dual anti-platelet therapy'). The biggest risk factor for stent thrombosis is premature discontinuation, or reduction in the intensity of, antiplatelet therapy (i.e before re-endothelialisation is complete).
- aspirin should be continued indefinitely for secondary prevention, but the duration of clopidogrel therapy is determined by the clinical setting
- patients whose stents - bare metal stents (BMS) or drugeluting stents (DES) - were implanted for a non-ST elevation myocardial infarction should be treated for 12 months
- logically, this recommendation also applies to patients treated for ST elevation infarction, though this indication has yet to be tested by formal clinical trial
- patients with stable angina treated with a bare metal stent should take clopidogrel for at least one month
- patients receiving a DES should continue clopidogrel therapy for 6-12 months. Because of the uncertain risk of thrombosis with DES, even >12 months after placement, some cardiologists feel that clopidogrel therapy should be indefinite
Reference:
- (1) British Heart Foundation Factfile (May 2008). Managing patients with coronary stents.