Why do individuals with implanted heart stents need to carry a stent card?

Why Patients Need to Carry a Stent Card

Patients with heart stents need to carry a stent card primarily because it provides critical medical information that helps prevent potentially life-threatening stent thrombosis in emergency situations or when undergoing medical procedures that might require temporary discontinuation of antiplatelet therapy.

Importance of Dual Antiplatelet Therapy (DAT)

• Stent thrombosis is a serious complication after stent implantation that often presents as myocardial infarction or even death 1
• After stent placement, patients are maintained on dual antiplatelet therapy (DAT) which is critical in preventing stent thrombosis 1
• Premature discontinuation of DAT is highly associated with stent thrombosis, especially during the minimum required duration (3 months for sirolimus-eluting stents and 6 months for paclitaxel-eluting stents) 1
• The tight relationship between DAT and stent thrombosis for patients with drug-eluting stents (DES) warrants emphasis and has significant implications for patient management 1

Medical Identification in Emergency Situations

• A stent card contains essential information about:

  • The type of stent implanted (bare-metal or drug-eluting)
  • Date of implantation
  • Location of stent placement
  • Required duration of antiplatelet therapy
  • Contact information for the treating cardiologist 1

• This information is crucial for healthcare providers in emergency situations when patients may be unable to communicate their medical history 1

Management of Elective Procedures

• Patients should contact their treating cardiologist before stopping any antiplatelet therapy, even if instructed to do so by another healthcare provider 1
• Healthcare providers who perform invasive or surgical procedures must be aware of the potentially catastrophic risks of premature discontinuation of antiplatelet therapy 1
• The stent card helps inform these providers about the specific stent type and implantation date, which determines the risk period for stent thrombosis 1

Different Risk Periods Based on Stent Type

• For bare-metal stents (BMS), the minimum duration of DAT is typically 4 weeks 1, 2
• For drug-eluting stents (DES), the minimum duration is longer:
  • At least 3 months for sirolimus-eluting stents
  • At least 6 months for paclitaxel-eluting stents
  • Ideally extended to 12 months for all DES 1
• The risk of stent thrombosis is highest in the first month after implantation, with risk gradually decreasing over time 1

Special Considerations for Specific Patient Groups

• Patients with stents implanted for myocardial infarction have a higher risk of adverse events (7.5%) compared to those with stents for other indications (2.6-2.7%) 1
• Patients with high-risk features (diabetes, multivessel disease, multiple stents, etc.) may require longer antiplatelet therapy and special considerations for any procedures 1

Common Pitfalls to Avoid

• Routine dental procedures should not justify cessation of DAT even if it is anticipated that DAT will be subsequently resumed 1, 3
• Elective procedures with significant risk of bleeding should be deferred until patients have completed an appropriate course of antiplatelet therapy 1
• If DAT must be interrupted, aspirin should be continued if at all possible, and the antiplatelet medication should be restarted as soon as possible after the procedure 1

Conclusion

Carrying a stent card is not merely a formality but a critical safety measure that ensures appropriate medical care, particularly in emergency situations or when procedures requiring antiplatelet therapy adjustment are needed. The card serves as an important communication tool between different healthcare providers involved in the patient's care, potentially preventing life-threatening complications like stent thrombosis 1.