A 54-year-old man is seen in the orthopaedic pre-assessment clinic. He has had stable angina and, in addition to medical therapy, has had disease in a dominant RCA treated with a zotarolimus-eluting stent 5 months previously. He is taking aspirin, clopidogrel, simvastatin, ramipril, and bisoprolol. He is free from angina, has a resting BP of 113/80 mmHg, and a heart rate of 48 bpm. His blood results are within normal limits, including a fasting total cholesterol of 3.2 mmol/L.
You are asked about changes to his medication.
Which one of the following would you agree with?
A. Stop aspirin and clopidogrel; the risks of bleeding outweigh the risks of stent thrombosis ase the angioplasty was >1 month agoDrug-eluting stents carry a risk of stent thrombosis that continues out to 12 months, with reports of very late stent thrombosis beyond. Recommendations advise continuing dual-antiplatelet therapy for >12 months. The POISE trial investigated the effect of a non-titrated dose of long-acting metoprolol in the perioperative period. Compared with placebo, there was a higher incidence of stroke in this group. However, several other trials suggest a protective benefit of beta-blockers, and the recommendation is to continue treatment.
NB: Currently emerging data suggest that everolimus and biolimus (with biodegradable polymers) eluting stents are safe with shorter durations of dual antiplatelets (3–6 months), but the question is based on current guidance