THURSDAY, Jan. 11, 2007 (HealthDay News) -- A leading cardiology association issued a "clinical alert" Thursday to help guide physicians in reducing the risk of blood clots when inserting drug-eluting stents in heart patients.
"We view this as sort of a wake-up call and back-to-basics approach," said Dr. John Hodgson, lead author of the alert, a past president of the Society for Cardiovascular Angiography and Interventions (SCAI), and chief of academic cardiology at St. Joseph's Hospital and Medical Center in Phoenix. "We've all gotten a little bit complacent with drug-eluting stents."
The SCAI issued the alert, which was published online as part of the organization's official journal, Catheterization and Cardiovascular Interventions.
Stents are small, mesh tubes that prop open narrowed arteries. Traditionally, bare metal stents, which perform a purely mechanical function, were used. But these stents carry a risk of reclosing -- or restenosis -- of the artery, which, in turn, requires additional surgery.
Drug-eluting stents were introduced three years ago and have now become dominant tools in the field of cardiovascular surgery. These stents slowly release a medication that prevents the build-up of scar tissue, which can result in reclosing of arteries. But recent evidence suggests that drug-eluting stents carry a risk of producing potentially dangerous blood clots.
In December, a U.S. Food and Drug Administration advisory panel recommended that drug-eluting stents stay on the market but with caveats, including updated labeling and additional research.
An estimated 6 million people worldwide have received drug-eluting stents, 3 million of them in the United States.
"One of the harsh realities is that we find ourselves in a moment in time where we have raced ahead with technology and applied it broadly to many patient types in the absence of good data and probably with good intent," said Dr. Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City and a member of the board of trustees of SCAI. "But we're probably learning that at least in some of the patients, we need to be circumspect before putting in a drug-eluting stent."
The new alert is directed to interventional cardiologists and gives advice on how to evaluate and reduce the risk of late stent thrombosis -- blood clots after stent placement. Among the recommendations:
Heart specialists pointed out that, despite the problems, the stenting procedure is still relatively safe.
"I don't think the data are as alarming as some have made them out to be," Garratt said. "For the typical patient who's in their 60s, 70s or 80s, for the remaining 20 years of life, we would expect them to have an increased risk of 2 to 3 percent, but that's not very much when you consider the benefits that they're getting."
More information
Visit the American Heart Association for more on stents.