Blood thinner treatment after stent surgery

In people with coronary heart disease, the narrowed coronary vessels are often dilated with a catheter and then supported with a tiny metal tube (stent). This operation improves the blood circulation, potentially preventing a heart attack. After the operation however, the stent poses the risk of a blood clot, which then impedes the blood flow. Patients therefore receive a blood thinner, which prevents platelets from sticking together at the stent. Blood thinners are usually prescribed for a period of 6 to 12 months, or in some cases over a longer period.

This summary of a Canadian HTA report compares the two therapeutic approaches in terms of their efficacy and costs.

The study results were based on high-quality data and showed that the prolonged treatment over more than 12 months reduced the risk of a heart attack and thrombosis at the stent, although the risk of bleeds posed by the longer treatment was higher. Overall, there were no clear differences between the two therapeutic approaches in terms of the risk of death, a stroke or other serious adverse events. The greatest benefit of the prolonged treatment was observed in those who had already had a heart attack or who suffered from acute heart problems.

The report concludes that individuals with coronary heart disease benefit from the continuation of blood-thinning treatment beyond 12 months, since the risk of a heart attack or further narrowing of the vessels is reduced. From the economic standpoint, and despite the rather uncertain data situation, the report shows a small additional benefit for the prolonged treatment, especially in terms of prevention. Follow-up studies are needed to assess the economic benefit in Switzerland.