Very late thrombosis after sirolimus-eluting stent implantation

Pasceri, Vincenzo; Pelliccia, Francesco; Cianfrocca, Cinzia; Pristipino, Christian; Santini, Massimo; Richichi, Giuseppe

doi:10.2459/01.jcm.0000228697.99654.4d

Cited by 11 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Duration of DAPT, however, was questioned when case reports of very late stent thrombosis were published. 35 On December 7 and 8, 2006, the US Food and Drug Administration (FDA) convened an advisory panel meeting to discuss stent thrombosis and the overall safety of DES. 36 Despite the lack of any scientific background, 37 the advisory panel concurred with the joint clinical practice guideline recommendation for 12 months of DAPT after placement of a DES in patients who are not at high risk of bleeding.…”

Section: Trials On Optimal Duration Of Dual Anti-platelet Therapymentioning

confidence: 99%

Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention

Barillà

Pelliccia

Borzi

et al. 2017

Journal of Cardiovascular Medicine

Self Cite

View full text Add to dashboard Cite

Definition of the optimal duration of dual anti-platelet therapy (DAPT) is an important clinical issue, given the large number of patients having percutaneous coronary intervention (PCI), the costs and risks of pharmacologic therapy, the consequences of stent thrombosis, and the potential benefits of DAPT in preventing ischaemic outcomes beyond stent thrombosis. Nowadays, the rationale for a prolonged duration of DAPT should be not only the prevention of stent thrombosis, but also the prevention of ischaemic events unrelated to the coronary stenosis treated with index PCI. A higher predisposition to athero-thrombosis may persist for years after an acute myocardial infarction, and even stable patients with a history of prior myocardial infarction are at high risk for major adverse cardiovascular events. Recently, results of pre-specified post-hoc analyses of randomized clinical trials, including the PEGASUS-TIMI 54 trial, have shed light on strategies of DAPT in various clinical situations, and should impact the next rounds of international guidelines, and also routine practice. Accordingly, the 2015 to 2016 the Board of the Italian Society of Cardiology addressed newer recommendations on duration of DAPT based on most recent scientific information. The document states that physicians should decide duration of DAPT on an individual basis, taking into account ischaemic and bleeding risks of any given patient. Indeed, current controversy surrounding optimal duration of DAPT clearly reflects the fact that, nowadays, a one size fits all strategy cannot be reliably applied to patients treated with PCI. Indeed, patients usually have factors for both increased ischaemic and bleeding risks that must be carefully evaluated to assess the benefit/risk ratio of prolonged DAPT. Personalized management of DAPT must be seen as a dynamic prescription with regular re-evaluations of the risk/benefit to the patient according to changes in his/her clinical profile. Also, in order to derive more benefit than harm from new treatments, a multi-parametric approach using several risk scores of the ischaemic and bleeding risks might improve the process of risk factor characterization. In patients with high ischaemic risk, particularly those with a history of myocardial infarction, the benefits of extended DAPT (particularly with ticagrelor up to 3 years) are likely to outweigh the risks.

show abstract

Section: Trials On Optimal Duration Of Dual Anti-platelet Therapymentioning

confidence: 99%

Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention

Barillà

Pelliccia

Borzi

et al. 2017

Journal of Cardiovascular Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite the implementation of numerous techniques to stent both branches, none has shown clinical and angiographic superiority to the main branch (MB) stent technique with provisional T-stenting of the side branch (SB) in case of dissection or residual severe disease [2]. In addition, concerns have been raised about safety of drug-eluting stents (DES) because of the greater late and very late [3] stent thrombosis and mortality as compared to bare metal stents (BMS). Also, technical characteristics of stents (i.e.…”

mentioning

confidence: 98%

Randomized study on provisional stenting with sirolimus-eluting stent vs. bare metal stent for the treatment of true coronary bifurcations: The PROSUMER (PROvisional with sirolimus-eluting vs. bare metal stents in truE bifuRcations) study

Tanzilli¹,

Pelliccia²,

Pasceri³

et al. 2011

International Journal of Cardiology

Self Cite

View full text Add to dashboard Cite

“…Arterielle endotheliale Heilungsprozesse nach DES-Implantation verlaufen langsamer als nach BMS und spielen auch beim Auftreten später Stentthrombosen eine wichtige Rolle [5]. Das Absetzen von Clopidogrel im ersten Jahr nach DES-Implantation ist mit einem erhöhten Risiko für Stentthrombosen vergesellschaftet [6,7,8,9,12]. Daraus resultierende ST-Hebungsinfarkte sind mit einer hohen Mortalität von bis zu 45% der Fälle verbunden [2, 4,14].…”

unclassified

Akuter Herzinfarkt nach Absetzen von Acetylsalicylsäure 2 Jahre nach Implantation eines Medikamenten-freisetzenden Stents

Krüth

Heer²,

Senges³

et al. 2007

Dtsch med Wochenschr

View full text Add to dashboard Cite

Discontinuing antiplatelet therapy, even years after implantation of a drug-eluting coronary stent, increases the risk of a late stent thrombosis. This should be taken into account especially before any procedure, even with a low bleeding risk such as tooth extractions. Antiplatelet treatment should be continued, even if there is a risk increasing minor bleeding complications, so that any life-threatening complication of an acute myocardial infarction is avoided.

show abstract

Very late thrombosis after sirolimus-eluting stent implantation

Cited by 11 publications

References 13 publications

Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention

Optimal duration of dual anti-platelet therapy after percutaneous coronary intervention

Randomized study on provisional stenting with sirolimus-eluting stent vs. bare metal stent for the treatment of true coronary bifurcations: The PROSUMER (PROvisional with sirolimus-eluting vs. bare metal stents in truE bifuRcations) study

Akuter Herzinfarkt nach Absetzen von Acetylsalicylsäure 2 Jahre nach Implantation eines Medikamenten-freisetzenden Stents

Contact Info

Product

Resources

About