Important Issues in Stenting & Antiplatelet Therapy

Read this article about not removing patients from therapy prior to elective dental surgery.


Continuing dual antiplatelet therapy after placement of a drug-eluting stent for at least one year is important to improving patient outcomes. Educating patients and providers about the hazards of premature discontinuation is critical.

Published studies have demonstrated that using dual antiplatelet therapies—specifically thienopyridines (eg, clopidogrel or ticlopidine) and aspirin—can significantly reduce the incidence of early major adverse cardiac events after a stenting procedure has been performed. In fact, dual antiplatelet therapy is more effective than using aspirin alone or in combination with warfarin in reducing the incidence of these events. Current practice guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) on the treatment of patients undergoing percutaneous coronary intervention and for treating patients with non–ST-segment–elevation acute coronary syndromes recommend using thienopyridines in combination with aspirin therapy.

Despite documented benefits, Cindy L. Grines, MD, FACC, says that dual antiplatelet therapy is sometimes prematurely discontinued within the first year after stent implantation. “Dual antiplatelet therapy can be discontinued too early by the patient or by a provider because they may be unaware of the benefits of these agents,” she says. “Other clinicians may prematurely discontinue these therapies because of the perceived risk of bleeding.” Research has shown that the leading adverse event associated with early antiplatelet discontinuation is stent thrombosis (Table 1); the majority of these events lead to acute myocardial infarction or death. Dr. Grines says that the mortality rates due to presumed or documented stent thrombosis range from 20% to 45%.

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Comments

Himro said…
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Visit and Give me your comment..link is here http://dentistryandmedicine.blogspot.com/2011/06/management-of-dental-patient-on.html