Stents

 - also see PreOp Eval
Dual anti-platelet therapy ollowing placement of a drug-eluting coronary artery stent
  • The recommended duration = 1 year.
  • The recommended dosages:
    • Aspirin, 162-325 mg, and clopidogrel, 75 mg, OR prasugrel, 10 mg.
    • Ticlopidine is an option for patients who do not tolerate clopidogrel or prasugrel.
  • The minimum recommended duration of dual anti-platelet therapy is
    • 1 month with bare-metal stents (Generally 6 weeks)
    • 3 months with sirolimus-eluting stents,
    • 6 months with other drug-eluting stents (generally 1 year).
    • Bare metal
      – Bare metal acts as foreign body, increasing risk of in-stent thrombosis
      clopidogrel + ASA decreases risk; continue 1 month post-stent if no MI (or 12 months if post-MI)
      – Endothelialization may progress to in-stent stenosis
    • Drug-eluting
      – Delay endothelialization, maintaining bare metal longer; continue clopidogrel + ASA for 12 months
      – Sirolimus (Cypher), tacrolimus (Mahoroba), paclitaxel (Taxus)