More information on the safety of drug-coated stents
The November 12 issue of the New York Times reported that the medical and pharmaceutical industries are re-examining the issue of drug-coated stents. These stents had been in widespread use over the past decade as a means of reducing the likelihood of re-clotting at the location of a stent used to preserve the integrity of coronary arteries. Over the past 18 months, research had suggested, however, that drug-coated stents presented a new hazard of later-developing clots. As a result, there was a dramatic reduction in the use of drug-coated stents, with the NYT suggesting that the sale of these stents dropped from 6 billion to 5 billion dollars over the last year. Very sick patients opted for open-heart surgery as an alternative, while other coronary artery disease patients chose bare metal stents or chemotherapy alone. Patients treated with drug-coated stents were placed on a longer regimen of anti-clotting medications as a precaution.
Newer studies have demonstrated that the issue is not as simple as originally thought, however. Some studies have suggested that perhaps the original studies identifying the risk of clotting may be skewed because drug-coated stents were used in sicker patients. Another study of 17,000 patients suggests that the survival of drug-coated stent patients is better, long-term, than the survival of bare-metal stent patients. Other physicians point to the risks and complications of open-heart surgery that must be weighed against the risk of late-developing clots. It will probably require several years of experience and more subtle investigation to tease out the "truth" about drug-coated stents. In the meantime, this is an issue that should be examined carefully by every patient and his or her physicians.