Key result
DAPT discontinuation linked to very late DES thrombosis while a prior BMS remains patent.
Why the study?
Late stent thrombosis occurs more frequently with drug-eluting stents and is closely associated with discontinuation of dual antiplatelet therapy.
Case Report (n=1)
No
This case highlights the potential vulnerability of drug-eluting stents to very late thrombosis following discontinuation of dual antiplatelet therapy compared to bare-metal stents.
Case suggests caution discontinuing DAPT after DES; hypothesis-generating for differential very late thrombosis risk versus BMS.
Drug-eluting stents (DESs) are the treatment of choice for obstructive coronary artery disease when percutaneous intervention is feasible. However, late stent thrombosis seems to occur more frequently with DESs and is closely associated with the discontinuation of dual antiplatelet therapy. We report a case of very late stent thrombosis after discontinuation of dual antiplatelet therapy. The patient suffered from acute myocardial infarction (MI) and underwent bare metal stent (BMS) implantation in the left anterior descending artery (LAD) five years prior to presentation. Three years after BMS implantation, he presented again with acute MI and had a DES implanted in the right coronary artery (RCA). He ran out of his medication, but failed to refill his prescription. Sixteen days after discontinuing medication, he experienced an episode of chest pain and was taken to the cardiac catheterization laboratory, where he was found to have thrombosis in the DES, but no thrombosis in the BMS. It is possible that DESs are more vulnerable to late thrombosis than are BMSs, supporting the use of prolonged dual antiplatelet therapy in patients treated with DESs. The patient was successfully treated with balloon angioplasty and thrombus aspiration without complications.
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Kim et al. (2009) conducted a case report in Very late stent thrombosis (n=1). Discontinuation of dual antiplatelet therapy was evaluated on Stent thrombosis. Discontinuation of dual antiplatelet therapy resulted in very late stent thrombosis in a drug-eluting stent, while a previously implanted bare-metal stent remained patent.
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