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How Long Should You Stay on Blood Thinners After a Stent

We get a ton of emails and visits from people wanting to get off blood thinners after a stent. People are not satisfied by the typical cardiologist’s recommendation, ” Stay on them for life.”

I am not satisfied with that answer and you shouldn’t be either. We can do better.

In this post, I will discuss:

  • What is a stent
  • Blood-thinners after a stent and why they are necessary
  • Mainstream blood-thinner protocols
  • An alternative to the standard protocol for immediately after a stent 

What is a stent

If an angiogram was performed, and one or more blockages were found, the cardiologist determined that one or more stents would be beneficial.

A stent is a metal device that keeps arteries open after an angioplasty. Angioplasty was the first intravascular (inside the artery) therapy to open a blood vessel using a balloon over a wire inserted into the vessel. Unfortunately, opening with a balloon led to many failures in the short-term with sudden closure of the artery and in the long-term with a repeat blockage in the same area called a re-occlusion.

Stents were developed to limit the short-term sudden closure. But first-generation stents led to scar tissue, that over time, led to a repeat blockage. Second generation stents were then coated with chemotherapy drugs to limit scar tissue formation.

Blood-thinners after a stent

To prevent sudden blockage after a stent, aspirin and a more advanced platelet blocker was added. Platelets are part of the blood clotting system that aspirin works on. These have brand names like Plavix, Brilinta, and Effient. Together, aspirin and one of these agents is called DAPT, or Dual Anti-Platelet Inhibitor Therapy.

The longer the duration of the DAPT, the less likely the stents will shut down. This can be good. But these are heavy-duty blood thinners that can lead to much higher bleeding rates.

So, the question becomes one of risk versus benefit. What is the risk of a major bleed versus the risk of a stent shutting down? Both events can be catastrophic and life-threatening.

How long should you be on blood thinners?

Many studies have assessed the optimal duration of DAPT. Again, the studies look at bleeding risk versus sudden-blockage risk, otherwise known as acute stent thrombosis.

I wrote a blog in 2015 discussing a trial reported in the British Medical Journal. At that time, a meta-analysis looked at 10 randomized trials with over 32,000 patients. Short term dual anti-platelet therapy (DAPT) was associated with less bleeding and NO INCREASE IN HEART ATTACKS compared with 12 months of therapy. Short term therapy is roughly defined as around 6 months.

The authors also looked at long term dual anti-platelet therapy greater than 12 months. When DAPT was continued longer than 12 months, heart attacks were less likely. Sounds good so far.

The bad news is that major bleeds were 62% more common and the death rate was 30% higher!

Calculate Your Risk

A calculator was produced a couple of years ago and points are awarded for risk factors. The more risk factors, the more points, and the higher the risk of the stent shutting down. Less of these risk factors meant that the risk of bleeding is too high, and duration of DAPT should be shorter.

Here are the risk factors in the calculator:

  1. Age– the older the person, the higher the risk of bleeding
  2. Diabetes– individuals with diabetes has a higher risk of stent thrombosis
  3. Previous heart attack– higher risk of thrombosis
  4. Peripheral artery disease– higher risk of thrombosis
  5. Cardiomyopathy– higher risk of thrombosis
  6. Hypertension– higher risk of thrombosis
  7. Smoker in the last two years– higher risk of thrombosis
  8. Renal insufficiency– higher risk of thrombosis

Other factors in the DAPT score to be considered that increase the risk of thrombosis include whether this event was during a heart attack (versus elective and lower risk), smaller stent size, and stenting an older bypass graft.

The DAPT calculator can be found here. I have taken a screenshot so you can see what it looks like.

If the score is in the green territory from -2 to 3, 6 months of DAPT is appropriate. 4 and above should receive at least 12 months of DAPT or longer. Those people at 4 and above are at much higher risk of the stent shutting down.

Is There an Alternative?

I have a different approach to the above plan. It is based on the fact that in our office we work to make you much healthier than the people in the studies that led to the creation of the DAPT score. Let’s face it. The people in the studies LIKELY do not eat well and do not follow a healthy lifestyle. You can imagine that ice cream eaters who have lousy sleep habits, are couch potatoes, and don’t get much sun are at higher risk than our mythical “Paleo Person.”

So, follow me on this. 3-6 months of DAPT if your score is below 4, and 6-12 months if your score is 4 or above.

I think you are at much lower risk of shutting down that stent if you follow the Paleo lifestyle. I discuss these topics in my book, The Paleo Cardiologist, the Natural Way to Heart Health. The following recommendations can be done with OR without DAPT.

  1. Eat organic Paleo foods. Sticking with our ancestral foods minus any chemicals like GMO’s, pesticides, and artificial ingredients will go a long way toward keeping your stent open. Read more about our Paleo Pyramid.
  2. Get quality sleep. Our ancestors went to sleep with the sundown and awoke with the sunrise. Following that plan is a great idea as it lowers inflammation, something linked to stent thrombosis. Here is a post on 10 Ways to Better Sleep.
  3. Soak up the sun. The sun makes blood flow better and will keep your stent nice and slick. It is a natural anti-inflammatory, too.
  4. Heal your environment. Evaluate everything you bring into your house. Is it natural or not? If not, do not bring it in. These chemicals lead to sluggish blood flow and sticky blood.
  5. De-stress. Poor mental health leads to blood vessels that are clamped down. In this situation, blood stagnates, which is never good for a stent.
  6. Be active. Keep the heart pumping with outdoor activity and interval training. The more you work your heart muscle, the less chance you clog the stent.
  7. See your chiropractor. Good autonomic nervous system function is essential to proper blood flow and preventing stagnation. The chiros rule the autonomic system.
  8. 21st century lab testing. Most cardiologists just check the basic lab tests. Not me. By assessing markers like inflammation, oxidative stress, vitamin D, omega 3, homocysteine, intracellular nutrients, glutathione, food sensitivity, leaky gut, etc. AND optimizing the results, I think we can place you at the lowest risk of the stent shutting down. Here is post on the Top 5 tests you need for heart health.
  9. Evidence-based supplements. Please check out my post 10 Natural Blood Thinners. Typically, I use a nattokinase product, my organic beetroot powder and high dose omega-3, along with the above recommendations.

Talk with your doctor to see if this plan is right for you OR come out to Arizona and we can talk about it.

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