Thrombosis after Stent Implantation: How Much of a Problem is there?

Drug-eluting stents reduce the occurrence of in-stent restenosis and the need for subsequent target vessel revascularization when compared with bare-metal stents. However, drug-eluting stents may be associated with delayed (or absent) endothelialization, localized hypersensitivity reactions and late stent thrombosis. Stent thrombosis is a catastrophic event, resulting in life-threatening complications. Although larger, adequately powered, randomized trials are needed to fully assess the net clinical effects of drug-eluting stents compared with bare-metal stents, the evidence, thus far, appears to suggest that the net clinical benefit of drug-eluting stents may outweigh their risks. Premature discontinuation of antiplatelet therapy is the most important predictor of stent thrombosis; therefore, patients who are candidates for implantation of drug-eluting stents should be screened for their ability to receive and tolerate uninterrupted antiplatelet therapy longer than is necessary with bare-metal stents.