Drug-Eluting Stents: Warning to Cardiologists

Chicago, ILThe Society for Cardiovascular Angiography and Interventions (SCAI) has issued a statement warning cardiologists to be careful when treating arteries with drug-eluting stents.

The SCAI said that, although it still supports the use of drug-eluting stents, physicians must be vigilant in how they use the stents. Specifically, the organization warned doctors to carefully select patients who would benefit from the stents, be very careful when implanting the stents, and have patients use blood thinners in order to prevent clots.

Drug-eluting stents have come under scrutiny since doctors learned that there was a serious risk for blood clots developing after the stents have been implanted. A study published in the Journal of the American College of Cardiology earlier this month found that six months after implantation of drug-eluting stents, patients had 30 to 40 percent less coronary collateral function than patients with bare-metal stents.

Last month a U.S. Food and Drug Administration (FDA) advisory panel reviewed the debate over drug-eluting stents, concluding that in appropriate patients the benefits of the stents are greater than the risks. However, the panel did say that more research was needed in the matter and issued a warning that drug-eluting stents should not be used for "off-label" purposes.

Drug-eluting stents are used to keep narrowed arteries in the heart open and are covered with medication to help prevent the build-up of scar tissue in the stent. However, recent studies have found that patients with drug-eluting stents implanted are more likely to suffer a blood clot inside the stent than patients with bare metal stents. These blood clots can lead to fatal heart attacks.

The SCAI website lists recommendations for physicians considering recommending drug-eluting stents to patients:

• The drug-eluting stent should only be used when the benefits of preventing restenosis (reblocking of the arteries) outweigh the risks of late stent thrombosis
  
  
• The patient must be willing and able to take two different anti-clotting medications for at least six months following implantation of the stent;
  
  
• The drug-eluting stent must be properly implanted
  
  
• Both the patient and the physician must be informed about the importance of using two anti-clotting medications after implantation of the drug-eluting stent.

Drug-eluting stents, also known as medicated or drug-coated stents, are manufactured by Boston Scientific (Taxus stent, coated with sirolimus) and Cordis, a subsidiary of Johnson & Johnson (Cypher stent, coated with paclitaxel). In addition to thrombosis, drug-eluting stents have been linked to severe allergic reactions.