Medication after stenting

[mikesalad123]

Hi, I have some questions,
Is it possible to just take Plavix or Aspirin without getting stents?
Does one who got stented require to take medication forever?
Also, how much blockage is necessary to require a stent?

If any one could help me out I would greatly appreciate it. Thanks - Mike.

[kenkeith]

"More to the point, why clotting could be more of a problem with DES over BMS".
That's an interesting point and way is an individual at risk up to a year or so?.

Because the stent is a foreign object that will incite an immune response. This may cause scar tissue or cell proliferation to rapidly grow over the stent (Are there degrees of immunity response, rejection?) . Additionally, there is a strong tendency for clots to form at the site where the stent damages the arterial wall.

"Thrombosis is among the most dangerous side effects of DES treatment. The risk also exists with non-medicated metal stents, but a disturbing trend has appeared in drug-coated stents where patients experience a linear and cumulative rate of thrombosis over time.  The release of drugs from the stent can lead to delayed healing and actually increase the likelihood of thrombosis at the stent site". (appearantly delayed healing is the culprit?

[ed34]

Yes thats correct. It is assumed that the Lumen will have reformed inside the stent after one year, creating a clean, smooth, natural surface. Once trapped behind the stent and with new lumen formed, it should be unlikely that a clot will form. The problem with lumen growth in a BMS or a DES is not the concern. The concern is controlling scarred tissue growth. Before a Lumen is formed, the body seems to fill the area with a temporary scarred tissue which can be so large it restricts blood flow, blocking the stent.
The chemical on the DES inhibits scarred tissue growth, only allowing the normal Lumen cells to repair the area. BMS have no such protection. Scarred tissue is also rough and can encourage clotting. So I really don't understand why clotting is an issue with DES. I know evidence suggests there is, but I can't understand why it happens.
More to the point, why clotting could be more of a problem with DES over BMS.

[kenkeith]

The usual protocol for the drug eluding stents is dual therapy of aspirin and plavix for a year.  The reason for plavix is that DES has a tendency to clot when compared to bare metal stents, and less a problem for restenosis (overgrowth of tissue within the lumen).  After a year medical consensus is to discontinue plavix as there is less risk for clots, but continue with aspirin for a lifetime.

There may be some individuals that have a higher risk for clots so plavix may continued indefinitely.  It seems, if an individual has large soft plaque buildup between the layers of the vessel(s), that condition can present a higher risk for rupture and the formation of clots so plavix may be recommended for longer periods of time. That's my understanding.

[ed34]

"I remember a study saying it makes no difference. It's not the ASA in the stomach that creates problems, but the ASA in the blood supply to the stomach "

All I know is it stopped the stomach pains I was getting.

[cblmn7]

Yes and i work outdoors out of a bucket truck on the lines.any time i get cut it takes a long time to get it to stop i took the 325mg of asprin for three yrs now i take the chewable 81mg asprin along with the plavix

[Ken_PA]

"gastric resistant variety"

I remember a study saying it makes no difference. It's not the ASA in the stomach that creates problems, but the ASA in the blood supply to the stomach

[ed34]

It sounds like he/she is putting a lot of faith in the plavix keeping your stents clear. But after a year you will obviously have a lot of new tissue covering the stents and the plavix will not have any benefit. I bet you bleed for a long time if you cut yourself. Aspirin is a nightmare for the digestive system, it is known as a cause for ulcerations. Do you take the gastric resistant variety?

[cblmn7]

I am not sure why i have to take plavix for life my cardioligst said i have to keep my blood thin. i dont know if its the multiple stents over the last 3 yrs or what i was also on 325mg asprin and finally got to cut it back to 81mg i was getting a upset stomach. i know i have stents holding open other stents i 2 locations. i have asked him to get off of it and he said he wouldnt recomend it. between that and the 50mg of metroporol and the lisinipril it makes me tired.im glad i only have a 10.00 copay on percriptions

[ed34]

Im intrigued, why do you have to take plavix for life? There is no evidence to suggest it offers any benefits after a year.
Aspirin is usually prescribed with or without stents to help lower the risk of clotting in the arteries. If you are known to have CAD, then Aspirin is usually taken for life. Plavix is normally taken for 12-18 months.

[cblmn7]

on the first question it depends on how much blockage you have they usually stent when the blockage is 70% or greater. depending on the type of stent you get and how bad your cad is will determine how long you stay on certain meds, like plavix some people take it for a year after a DES I have to take plavix for life. then there is other meds you may have to take depending on circumstances. i take metorporol, plavix, vytorin, lisinipril and a couple others for the rest of my life to help keep me from another heart attack, diet and excercise will help the most though.