Starting Jardiance in a Patient with Drug-Eluting Stent PCI
Yes, you can safely start Jardiance (empagliflozin) in a patient with a drug-eluting stent (DES) PCI, as there are no specific contraindications between SGLT2 inhibitors and coronary stents. The primary consideration should be maintaining appropriate dual antiplatelet therapy (DAPT) post-PCI while adding Jardiance to the treatment regimen.
Key Considerations When Starting Jardiance After DES PCI
Dual Antiplatelet Therapy Requirements
- Patients with DES require DAPT (aspirin plus P2Y12 inhibitor) for at least 12 months after PCI for ACS, or at least 12 months for non-ACS indications 1
- DAPT should not be interrupted prematurely without discussion with the cardiologist 1
- Patients should be counseled on the importance of DAPT compliance 1
Timing of Jardiance Initiation
- Recent evidence from the SAFE-PCI pilot study (2023) showed that empagliflozin use is safe regarding kidney function during elective PCI in patients with type 2 diabetes 2
- The EMMY trial (2023) demonstrated that very early administration of SGLT2 inhibitors after acute myocardial infarction appears to be as effective and safe as delayed initiation 3
Cardiovascular Benefits of Empagliflozin
- Empagliflozin has shown cardiovascular benefits in patients with heart failure with reduced ejection fraction, as demonstrated in the EMPEROR-Reduced trial 4
- A 2022 study showed beneficial cardiometabolic effects when empagliflozin was started one month prior to elective PCI and continued for 11 months afterward 5
Practical Recommendations
Ensure proper DAPT compliance:
- Confirm the patient is on appropriate DAPT (aspirin plus P2Y12 inhibitor)
- Verify there are no drug interactions between Jardiance and the antiplatelet medications
Monitor for potential side effects:
- Watch for volume depletion, especially in the first few weeks
- Monitor renal function, particularly if the patient is on other medications that affect kidney function
- Be alert for signs of diabetic ketoacidosis, especially in situations of acute illness
Patient education:
- Emphasize the importance of maintaining DAPT compliance
- Instruct on proper hydration, especially before any procedures involving contrast agents
- Advise on recognizing signs of hypoglycemia if on insulin or sulfonylureas
Special Considerations
- If the patient has heart failure or is at risk for heart failure post-MI, empagliflozin may provide additional benefits 4, 6
- For patients with renal impairment, monitor kidney function more closely, but recent evidence suggests SGLT2 inhibitors are generally safe even in this context 2
- If the patient is scheduled for any future procedures requiring contrast, standard nephroprotection protocols should be followed
In conclusion, starting Jardiance in a patient with a DES PCI is appropriate and may offer cardiometabolic benefits beyond glycemic control, provided that proper DAPT is maintained and the patient is monitored for potential side effects.