Preventing Coronary Stent Thrombosis and Post-Stent Complications

Thomas L. Schwenk, MD

A structured review supports long-term low-dose aspirin plus a P2Y12-receptor inhibitor for 1 year.

More than 90% of percutaneous coronary interventions also involve stent placement. Stent thrombosis is a major complication of stent placement, and preventing it is the main goal of post-stent management. To determine the optimal approach to post-stent management, researchers conducted a structured literature review of 91 randomized trials, systematic reviews, and meta-analyses.

Dual antiplatelet therapy with long-term, low-dose aspirin (75–100 mg daily) plus a P2Y12-receptor inhibitor (usually clopidogrel) for 1 year after stent placement is the standard recommendation. Although this recommendation applies to both drug-eluting and bare-metal stents, a shorter duration of clopidogrel therapy (minimum of 1 month) is considered to be permissible for patients who have received bare-metal stents for nonacute coronary syndrome indications. Higher doses of aspirin (>200 mg daily) are associated with a twofold higher risk for bleeding, with no additional benefit. Risk for stent thrombosis continues beyond 1 year; however, studies of P2Y12-receptor inhibitor use beyond 1 year show no benefit in the face of elevated bleeding risk. Large clinical trials of shorter and longer durations of P2Y12-receptor inhibition are under way.

Citation(s):

Brilakis ES et al. Medical management after coronary stent implantation: A review. JAMA 2013 Jul 10; 310:189.