Ask the doctor: Clot prevention drugs after a stent: How long?

Q. My cardiologist told me to take clopidogrel for a year after I received a stent. Now the year is up. I haven't had any bleeding problems. Should I keep taking it?

A. In addition to aspirin, doctors routinely prescribe clopidogrel (Plavix) for people who receive stents, the tiny metal mesh tubes placed in clogged blood vessels to improve blood flow. This medication stops blood components called platelets from clumping together and forming clots. The current guidelines generally recommend that people take the drug for a year. This advice assumes they don't have any side effects such as unusual bleeding, which can show up as severe nosebleeds or blood in the urine or stools. However, these guidelines are still evolving. Experts are currently reviewing new findings from large studies on the benefits and risks of taking clopidogrel and similar drugs for extended periods of time.

In my own practice, I sometimes advise people who haven't had any bleeding issues to continue taking clopidogrel beyond a year, depending on why they got a stent in the first place. For example, someone who received a stent after a heart attack or had a complex stenting procedure may benefit from taking clopidogrel longer than one year. But anyone who takes this medication should be reassessed periodically by the cardiologist who prescribed it. 

— Deepak L. Bhatt, MD, MPH
Editor in Chief, Harvard Heart Letter