Drug eluting stents (heart stents coated with drugs that inhibit blood clots) are placed in the hearts of more than a million Americans a year to treat coronary disease and generate about $5 billion a year in sales for the two companies that make them. But are drug eluting stents placing your life at risk?

We’ve covered various treatments of clogged heart arteries previously, and there is no question that heart stents have saved countless lives in the short term by preventing impending heart attacks or opening arteries while an attack is being treated. However drug eluting stents may result in the incident of what is known as stent thrombosis, or the formulation of a blood clot within the stent itself. While the drug eluting stent is time-releasing its drugs, it effectively stops the re-growth of muscle cells inside the stent. This results in a clot which in turn results in a heart attack.

Neither type of stent, bare metal stents nor drug eluting stents have been shown in rigorous clinical trials to improve long-term survival compared with open heart bypass surgery. In December 2006, an expert FDA panel concluded that drug-eluting stents are even more likely than bare-metal stents to cause thrombosis.

Stents, which come in varying sizes and designs, are inserted by a cardiologist though a small opening, typically in the leg. The stents are then snaked to the heart on a microscopic balloon that opens the artery and is removed after the stent is in place.

With bare metal stents, the main drawback is the tendency of the repaired artery to become clogged again (restenosis). Drug eluting stents can cut restenosis in half, but have now been found to carry their own dangerous risks - which in some cases may even prove fatal.

For people who receive drug-coated stents, the standard protection against clotting is what is known as “anti-platelet therapy” - a few months of aspirin and the blood-thinner drug Plavix. Problem is, aspirin is a known stomach irritant and Plavix causes severe rashes and bruising. To prevent the recurrence of clotting, the FDA recommends staying on Plavix for a year, and on aspirin forever.

Why have stents become so popular? Probably because drug eluting stents are less invasive and frightening than full-scale surgery. They also help avoid the potential side effects of heart drugs, which can include fatigue, sexual dysfunction, depression and light-headedness. Perhaps other patients are not being told that a bypass surgery may be a good option.

Recent studies have shown that bypass surgery could extend many patients’ lives longer than stents. Stents, when improperly used, might put patients at greater risk of blood clots, heart attacks or even death. Bypass surgery should be considered as a better, longer term alternative.

Sources:

• Duke University: Drug-Coated Stent Patients at Risk if Anti-Blood-Clotting Medication Discontinued
• Duke University: Coronary Stents Do Not Improve Long Term Survival
• The Mobile Register (Alabama) : Doctors debate risk, benefits of stents - Fred Tasker; July 3rd, 2007
• The Wall Street Journal: New studies hint at overuse of stents - Ron Winslow; January 23rd, 2007
• MSNBC.com : Some heart stents pose death risk;March 1st, 2007
• The New York Times: Doctors Rethink Widespread Use of Heart Stents - Barnaby J. Feder; October 21st, 2006.