Duration of Plavix After Renal Stent
For renal artery stents, clopidogrel 75 mg daily should be continued for at least 12 months after stent placement, followed by lifelong aspirin therapy. 1
Primary Recommendation
The American Heart Association and American College of Cardiology recommend clopidogrel therapy for a minimum of 12 months following renal artery stent placement in patients who are not at high risk of bleeding. 1 This recommendation applies regardless of whether a bare metal stent or drug-eluting stent was used in the renal artery.
Stent Type-Specific Durations
While the 12-month duration is the standard recommendation for renal artery stents, the minimum acceptable durations vary by stent type: 1
- Bare metal stents: Minimum 1 month, ideally extended to 12 months 1
- Sirolimus-eluting stents: Minimum 3 months, ideally extended to 12 months 1
- Paclitaxel-eluting stents: Minimum 6 months, ideally extended to 12 months 1
- Newer generation drug-eluting stents: Minimum 12 months 1
High Bleeding Risk Modifications
If the patient has a high bleeding risk where the morbidity from bleeding outweighs the benefit of continued antiplatelet therapy, earlier discontinuation may be considered: 1
- Bare metal stents: Minimum 2 weeks in high bleeding risk patients 1
- Drug-eluting stents: Minimum 3-6 months depending on stent type in high bleeding risk patients 1
However, premature discontinuation significantly increases the risk of stent thrombosis, which carries a 45% case fatality rate. 2 This risk must be carefully weighed against bleeding concerns.
Long-Term Aspirin Therapy
After completing the recommended duration of clopidogrel therapy, aspirin should be continued indefinitely at a dose of 75-162 mg daily. 1 Lower-dose aspirin (81 mg daily) is reasonable for long-term therapy to reduce bleeding risk. 1
Critical Counseling Points
Patients must be counseled on the importance of compliance with dual antiplatelet therapy and advised never to discontinue clopidogrel without discussing with their physician. 1 Premature discontinuation is one of the most significant risk factors for stent thrombosis, with one study showing an 89-fold increased risk when antiplatelet therapy is stopped early. 2
Common Pitfalls
The most dangerous pitfall is premature discontinuation of clopidogrel, particularly for elective procedures. 2 If non-cardiac surgery is required, aspirin should be continued if at all possible, and clopidogrel should be restarted as soon as feasible after the procedure. 3 The risk of stent thrombosis extends beyond traditional recommended durations, so vigilance is required even after completing the 12-month course. 3