Understanding and minimizing late thrombosis of drug-eluting stents.

Rabbat, Mark; Bavry, Anthony A.; Bhatt, Deepak L.; Ellis, Stephen G.

doi:10.3949/ccjm.74.2.129

Cited by 24 publications

(15 citation statements)

References 49 publications

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“…Although the DES reduced the restenosis rate (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) by preventing smooth muscle cell proliferation, it increased the rate of stent thrombosis (1,(25)(26)(27)(28) after 1 year (very late stent thrombosis), a result rarely seen in BMS. Late stent thrombosis may be caused by the poorly formed neointima over DES that has failed to cover and stabilize underlying thrombogenic yellow plaque.…”

Section: Atherosclerotic Neointima Over Desmentioning

confidence: 99%

Atherosclerotic and Thrombogenic Neointima Formed Over Sirolimus Drug-Eluting Stent

Higo

Ueda

Oyabu

et al. 2009

JACC: Cardiovascular Imaging

163

103

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Sirolimus DES promoted formation of atherosclerotic yellow neointima in the stent-implanted lesion at 10-month follow-up. Thrombus was detected more often on the yellow area than on the white area and was never detected where a stent was buried under white neointima. These data suggest that the increased potential risk of late stent thrombosis in DES lesions may be due to the newly formed yellow neotima and cholesterol-laden plaque.

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Section: Atherosclerotic Neointima Over Desmentioning

confidence: 99%

Atherosclerotic and Thrombogenic Neointima Formed Over Sirolimus Drug-Eluting Stent

Higo

Ueda

Oyabu

et al. 2009

JACC: Cardiovascular Imaging

163

103

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“…Because there is uncertainty about whether to continue clopidogrel indefinitely in the case of DES, further randomized trials are required [41]. Until such data are accrued, our practice has been to continue dual antiplatelet therapy indefinitely, assuming that the patient does not have any major bleeding problems during the first year of therapy [42].…”

Section: Clopidogrel and Stent Thrombosismentioning

confidence: 99%

Clopidogrel and risk for acute coronary events

Mood

Bhatt

2007

Curr Atheroscler Rep

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Clopidogrel bisulfate is a potent adenosine diphosphate receptor blocker that irreversibly inhibits platelet aggregation by preventing the activation of the glycoprotein IIb/IIIa pathway. This helps to prevent thrombus formation and resultant ischemic or thrombotic complications. Clopidogrel was proven to be superior to aspirin in the treatment of atherothrombotic diseases. Clopidogrel plus aspirin, known as dual antiplatelet therapy, is highly effective in patients with acute coronary syndromes or undergoing percutaneous coronary intervention. There is no apparent benefit of dual antiplatelet therapy in primary prevention. In this article, we review the benefits of clopidogrel as an antiplatelet agent and its role in the management of acute coronary syndromes and following percutaneous coronary intervention.

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“…[34][35][36][37] Late stent thrombosis is a rare complication of stenting and, even in studies that have indicated an increased risk with DES, the absolute risk remains low (,1.5%). 34,37 However, it is also a serious complication, resulting in MI in 60-70% of cases and mortality rates of nearly 50%, 38,39 and so any increase in the rate of late stent thrombosis is a cause for concern.…”

Section: Drug-eluting Stents: the Risksmentioning

confidence: 99%