Coronary Stents, Blood Thinners and Disease Prevention

This article has been updated with audio on July 25, 2025

Some may think that having coronary artery disease or a heart attack is not that big of a deal. That is because there are medical procedures that can open up a blocked artery. One way is to have a coronary stent.

A coronary stent is a medical device inserted into the blood vessels that supply the heart’s muscles (coronary arteries). Doing so increases the blood flow again and prevents heart damage.

However, it is wrong to think that after having a coronary stent placed, everything will be back to normal.

Coronary stents can get blocked. Since stents are man-made and foreign, the body will try to wall them off by developing new cells on top of them. That is why some stents are made with drugs in them (Drug-Eluting Stents) to prevent these cells from forming.

Stents are not as smooth as the inner lining of the blood vessels. Blood clots tend to form inside the stent and lead to another heart attack.

Blood Thinners to Prevent Clot Formation Inside the Stent

That is why 81 mg of aspirin should be taken daily, together with another blood thinner like clopidogrel (Plavix) or ticagrelor (Brilinta), for at least 12 months. That is in the 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes (6.2.1.2). Aspirin must be taken indefinitely.

A few weeks ago, I wrote an article about the Number Needed to Treat (NNT). NNT is the number of people who need to be treated with a drug for 1 person to benefit. The lower the number, the better.

There is an opposite of NNT, and that is called NNH. Number Needed to Harm (NNH). NNH is the number of people needed to take that medicine for one person to have a significant side effect or harm. In contrast to NNT, a low NNH number is terrible.

For the aspirin/clopidogrel combination, the NNH is 1 in 114. For the aspirin/ticagrelor combination, the NNH is 1 in 166. That means, in 166 patients who will receive the aspirin and ticagrelor, one will be harmed.

The “harm” in both situations is a significant bleeding event, most commonly from the gastrointestinal tract, requiring hospitalization and blood transfusion/s.  1 in 16 patients in the aspirin/ticagrelor combination also developed shortness of breath.

It is noteworthy to revisit the NNT of aspirin/ticagrelor, as a third-party, independent meta-analysis reveals that “No patients were helped.”  So, what is the basis of the AHA/ACC for the recommendation? They are from the two studies. Namely, this and this. Both are funded by AstraZeneca. The same company that makes ticagrelor. I wrote a little bit about the ACC in this article, Are You Skipping Breakfast?

Elective Surgeries Will Just Have to Wait

After an angiogram, it is also best to postpone any elective surgery for at least a month or while the patient is on double blood thinners. That is because the blood thinners should not be stopped or else a blood clot can form within the stent and lead to a heart attack. If there is a need to have emergency surgery for some reason, then the surgeon will have to weight what matters more.  Stopping the blood thinner and risk a heart attack or go ahead with the surgery and risk bleeding.

As of August 2019, the monthly price for Brilinta is $379 and Plavix is $11-$156.

Medical Conditions Often Require Medications and Procedures that may have side effects, necessitating additional medications with their side effects, which in turn may require further medications, and so on.

In summary, managing coronary heart disease is a complex process. The possibility of complications with any medical procedure always exists. Regarding a stent, there is a risk of clot formation inside the stent and another heart attack. Therefore, a blood thinner should be taken to prevent blood clots. The blood thinner then introduces the possibility of bleeding that can come from the stomach and/or the brain.

Real risks always exist whether a heart attack is treated conservatively with medications or aggressively with a clot-buster to dissolve a blood clot or with a heart bypass. Medications have to be taken to deal with the side effects of the other prescription drugs.

This article serves as an example of the complexity of medicine and the shortcomings of medications. Most medications, whether they be over the counter or prescribed, bring with them the possibility of unexpected and unwanted drug-drug and drug-patient interactions.

Take Away Message

Preventing disease is much better than getting sick. There is almost no risk associated with eating a low-carbohydrate diet. Even with intermittent fasting.  

The NNT of the Mediterranean diet to prevent a heart attack is 18, and no one was harmed. 1 in 18 benefited, but all had a great meal. 

The NNT for statins for preventing another heart attack in someone who already had a heart attack is 39, and the NNH for muscle damage is 10, and an NNH of 50 for developing diabetes.

The risk associated with exercise, when performed with the right technique and in a safe environment, is almost negligible.

A low-carbohydrate diet and exercise not only prevent coronary conditions but also other diseases associated with metabolic syndrome.

 

Don’t Get Sick!

Related:

1. The Deadliest Diseases Associated with Metabolic Syndrome
2. Atrial Fibrillation and Metabolic Syndrome
3. How Effective are Drugs that Increase HDL?
4. Can You Be in Heart Failure Now?
5. What Starts Atherosclerosis?
6. The Magical Endothelium
7. How Does Diabetes Destroy Arteries
8. How Diabetes Destroys the Body
9. Understanding Heart Failure Treatment
10. How Effective is Quitting Cigarettes?
11. Hair Loss and Heart Attacks
12. The Real Effect of Statins on Heart Disease
13. LDL: “Bad Cholesterol” is Not All Bad.

Image Credits:

Coronary Stent from the NIH

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