Drug-eluting stents placed during percutaneous coronary interventions are safer in the short-term than their bare-metal counterparts, greatly reducing the incidence of major cardiac events. Research has shown that dual antiplatelet therapy with aspirin and a thienopyridine reduces the risks of stent thrombosis (clotting within the stent), myocardial infarction, and death after stent placement. But it has also been found that many patients discontinue-or are taken off-antiplatelet therapy too early, increasing their risk of adverse events. Now, according to a joint advisory issued by the American Heart Association, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and others, patients should take antiplatelets for 12 months after receiving a drug-eluting stent.

A stent is a wire mesh tube used to prop open a blocked coronary artery, improving blood flow and relieving chest pain. A drug-eluting stent is coated with slow-releasing medication that inhibits restenosis; such stents are now used in a majority of cases.

Before a drug-eluting stent is placed, aspirin is often prescribed in combination with a thienopyridine, such as clopidogrel (Plavix) or ticlopidine (Ticlid), to reduce the risk of stent thrombosis. Such antiplatelet therapy may be discontinued prematurely because of high cost or inadequate patient instruction. Also, providers may instruct patients to stop taking "blood thinners" before a subsequent invasive or surgical procedure because of somewhat unwarranted concerns about excessive bleeding or without distinguishing between warfarin and antiplatelet medications. Many minor procedures can be performed with minimal risk during antiplatelet therapy, or they may be delayed.

The joint advisory stresses the importance of dual antiplatelet therapy for 12 months after drug-eluting stent placement. The advisory lists eight recommendations, including instructing patients to contact their cardiologist before stopping the medication and increasing collaboration among the health care industry, insurers, drug companies, and the government to ensure that drugs are affordable. Nurses can help make both patients and physicians aware of the need to continue antiplatelet therapy during a minor procedure or suggest postponing the procedure.-SDSJ