From the Guidelines
Patients with a stent in their left ventricle should avoid anti-inflammatory medications and/or supplements 2 years post-procedure because they can increase the risk of stent thrombosis and compromise stent patency [ 1 ].
Key Considerations
- Chronic steroid or NSAID therapy is associated with an increased risk of stent thrombosis, as outlined in Table 4 of the study [ 1 ].
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also increase the risk of bleeding and stent thrombosis [ 1 ].
- Supplements like omega-3 fatty acids and garlic extract may potentiate bleeding and interfere with platelet aggregation, thereby compromising stent patency.
Management Strategies
- Alternative pain management strategies should be considered to minimize the risk of stent thrombosis and bleeding complications.
- Close monitoring of cardiac function is essential to mitigate potential complications associated with long-term use of anti-inflammatory medications and supplements [ 1 ].
- The decision to use anti-inflammatory medications and supplements should be made on a case-by-case basis, taking into account the individual patient's ischemic and bleeding risk profiles [ 1 ].
From the FDA Drug Label
WARNINGS CARDIOVASCULAR EFFECTS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI) and stroke, which can be fatal Post-MI Patients Observational studies conducted in the Danish National Registry have demonstrated that patients treated with NSAIDs in the post-MI period were at increased risk of reinfarction, CV-related death, and all-cause mortality beginning in the first week of treatment
The patient with a stent in their left ventricle should avoid anti-inflammatory medications and/or supplements 2 years post-procedure because NSAIDs can increase the risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use 2. Additionally, patients with a history of myocardial infarction are at increased risk of reinfarction, CV-related death, and all-cause mortality when taking NSAIDs 2. It is recommended to use the lowest effective dose for the shortest duration possible to minimize the potential risk for an adverse CV event 2.
From the Research
Inflammation and Stent Implantation
- Inflammation plays a crucial role in the development of atherosclerosis and is associated with adverse clinical outcomes in patients after percutaneous coronary interventions 3.
- Vessel inflammation is one of the causes that may be related to stent restenosis as well as stent thrombosis 4.
Anti-Inflammatory Medications and Stent Implantation
- Systemic therapies targeting inflammation emerged as adjunctive pharmacological intervention to improve outcome after bare-metal stent implantation, including statins, corticosteroids, antiplatelets, and immunosuppressive or anti-cancer drugs 4.
- However, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX-2)-selective inhibitors in patients with coronary stents was not associated with an increased rate of major adverse cardiovascular events (MACE) in one study 5.
Risks Associated with Anti-Inflammatory Medications
- Potentially dangerous side effects of drug-eluting stents are adverse drug interactions, incomplete stent apposition, and increased in-stent thrombosis rates 6.
- Inflammation as a determinant of healing response after coronary stent implantation is an important consideration, and data on stent elements that lead to excessive inflammatory response are limited 3.