Recent downplay of the media’s attention to DES-related thrombosis during both the TCT and AHA conferences this fall may have been premature in light of a new study coming out of the Cleveland Clinic.
A meta-analysis published in the December issue of the American Journal of Medicine indicates that patients with drug-eluting stents have a four to five-fold increased relative risk for developing late thrombosis compared to those with bare-metal stents. It is the first published analysis of its kind, PRNewswire reports.
"Our analysis found there is a small, but real, hazard of late stent thrombosis with drug-eluting stents more so than with bare-metal stents, likely in the setting of discontinuation of anti-clotting drugs," said Deepak L. Bhatt, M.D., associate director of the Cleveland Clinic Cardiovascular Coordinating Center and one of the study's authors. "This does not, however, mean that drug-eluting stents should not be used, as other studies have shown that they do significantly reduce the need for repeat procedures compared with bare-metal stents."
Fourteen studies with 6,675 total patients were included in the analysis comprising nine sirolimus stent trials and five paclitaxel stent trials. Eight of the trials reported more than a year of clinical follow-up. The sirolimus trials mandated anti-clotting medication for at least two to three months and the paclitaxel trials required six months.
"The key to the controversy is likely careful patient selection," Dr. Bhatt said. "Further research is needed to determine how best to utilize drug- eluting stents and anti-clotting medications."