TY - JOUR
T1 - Appropriate use of drug-eluting stents
T2 - balancing the reduction in restenosis with the concern of late thrombosis
AU - Bavry, Anthony A.
AU - Bhatt, Deepak L.
N1 - Funding Information:
AAB has received honoraria for consulting from Boston Scientific, Genesis Associates, the Frankel Group, HRA, Propagate Pharma, and Hagen/Sinclair Research Recruiting. DLB has appeared on the speaker's bureau for Bristol Myers Squibb, Sanofi Aventis, and the Medicines Company; has received honoraria from AstraZeneca, Bristol Myers Squibb, Cardax, Centocor, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Millennium, Otsuka, Paringenix, PDL, Sanofi Aventis, Schering Plough, the Medicines Company, and TNS Healthcare; has acted as a consultant for or sat on the advisory board of AstraZeneca, Bristol Myers Squibb, Cardax, Centocor, Cogentus, Daiichi-Sankyo, Eisai, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Medtronic, Millennium, Otsuka, Paringenix, PDL, Portola, Sanofi Aventis, Schering Plough, the Medicines Company, tns Healthcare, and Vertex; has provided expert testimony about clopidogrel; and has received research grants (to Cleveland Clinic Cardiovascular Coordinating Center) as principal investigator or co-principal investigator for CHAMPION (the Medicines Company), CHARISMA (Bristol Myers Squibb, Sanofi Aventis), CRESCENDO (Sanofi Aventis), LANCELOT (Eisai), REACH (Bristol Myers Squibb, Sanofi Aventis), and STAMPEDE (Ethicon). Cleveland Clinic Coordinating Center currently receives or has received research funding from: Abraxis, Alexion Pharma, AstraZeneca, Atherogenics, Aventis, Biosense Webster, Biosite, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardionet, Centocor, Converge Medical, Cordis, Dr Reddy's, Edwards Lifesciences, Esperion, GE Medical, Genentech, Gilford, GlaxoSmithKline, Guidant, Johnson & Johnson, Kensey-Nash, Lilly, Medtronic, Merck, Mytogen, Novartis, Novo Nordisk, Orphan Therapeutics, Proctor & Gamble Pharma, Pfizer, Roche, Sankyo, Sanofi Aventis, Schering-Plough, Scios, St Jude Medical, Takeda, TMC, VasoGenix, and Viacor.
Funding Information:
Currently, the ideal duration of a dual antiplatelet regimen with drug-eluting stents is unknown, although the US Food and Drug Administration advisory committee has advocated 12 months of uninterrupted treatment. 4 This proposal is supported by the American Heart Association, American College of Cardiology, and European Society for Cardiology. 85 The optimum duration of dual antiplatelet treatment must balance the benefit of reduced ischaemic events against the harm from increased bleeding episodes.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2008
Y1 - 2008
N2 - Restenosis is a serious occurrence that can lead not only to recurrent angina and repeat revascularisation but also to acute coronary syndromes. Drug-eluting stents revolutionised interventional cardiology owing to their pronounced ability to reduce restenosis compared with bare-metal stents. Attention has now shifted to safety of these devices because of evidence suggesting an association with late stent thrombosis. Findings of randomised clinical trials have not shown that drug-eluting stents result in excess mortality after 4-5 years of follow-up. Current recommendations are that individuals with a drug-eluting stent should receive at least 12 months of uninterrupted dual antiplatelet treatment; patients must understand the importance of this long-term regimen. Patients' assessment should focus on bleeding abnormalities, pre-existing disorders that need anticoagulation treatment, and possible future surgical procedures, since these factors could all contraindicate use of drug-eluting stents. Many people will do well with a bare-metal stent, whereas for individuals with a high likelihood of restenosis and late thrombosis, medical management or surgical revascularisation might be preferred options.
AB - Restenosis is a serious occurrence that can lead not only to recurrent angina and repeat revascularisation but also to acute coronary syndromes. Drug-eluting stents revolutionised interventional cardiology owing to their pronounced ability to reduce restenosis compared with bare-metal stents. Attention has now shifted to safety of these devices because of evidence suggesting an association with late stent thrombosis. Findings of randomised clinical trials have not shown that drug-eluting stents result in excess mortality after 4-5 years of follow-up. Current recommendations are that individuals with a drug-eluting stent should receive at least 12 months of uninterrupted dual antiplatelet treatment; patients must understand the importance of this long-term regimen. Patients' assessment should focus on bleeding abnormalities, pre-existing disorders that need anticoagulation treatment, and possible future surgical procedures, since these factors could all contraindicate use of drug-eluting stents. Many people will do well with a bare-metal stent, whereas for individuals with a high likelihood of restenosis and late thrombosis, medical management or surgical revascularisation might be preferred options.
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U2 - 10.1016/S0140-6736(08)60922-8
DO - 10.1016/S0140-6736(08)60922-8
M3 - Review article
C2 - 18572082
AN - SCOPUS:45249091884
SN - 0140-6736
VL - 371
SP - 2134
EP - 2143
JO - The Lancet
JF - The Lancet
IS - 9630
ER -