Stent thrombosis

Gershlick and Richardson say that premature discontinuation of clopidogrel is the greatest risk factor for thrombosis of drug eluting stents.¹ In Iakovou's series thrombosis occurred in five of 17 patients (29%) who prematurely discontinued dual antiplatelet therapy.² One of them discontinued only clopidogrel, and the others stopped both antiplatelets (aspirin and clopidogrel or ticlopidine). We do not know whether continuation of aspirin alone would have been adequate to prevent thrombosis associated with drug eluting stents. Moreover, in only a minority of patients (five out of 29; 17%) did discontinuation of antiplatelets seem to have a role in the occurrence of stent thrombosis.

The tragedy of drug eluting stents is not the risk of late stent thrombosis but the fact that these devices have only a limited effect on patients' wellbeing. In several randomised trials they did not lead to a lower mortality and did not affect the incidence of acute myocardial infarction.³ On the other hand, recently presented meta-analyses and data from registries show that they might increase the occurrence of acute infarctions and even late mortality.^{4 5}