“What medications should I take after heart stent surgery?”

The quick and easy answer is dual platelet inhibition to maintain stent patency. The vast majority of stents now are drug eluding DES). The antibiotic /immunotherapy (ie sacrolimus) prevent latent stent stenosis by inhibiting the overgrowth of endothelial tissue from the lining of the artery and late thrombosis . The downside is that with delayed endothelial tissue formation ( stent doesnt become part of the artery lining) exposes the stent scaffolding to clotting factors and platelet activation. This can result in early thrombus/clot in the acute and subacute phase. By using dual platelet blockers that work at different receptors , there is adequate inhibition of platelet aggregation (clumping ) . Platelets are the first line in clotting before the coagulation cascade can be initiated (fibrin). Aspirin works by prostaglandin inhibition (certain prostaglandins promote thrombus ie thromboxane). The PGY2 inhibitors are clopidigrel, prasugrel and ticagrelor. The receptor is another mechanism of stimulating of platelet aggregation. blocking this receptor is more efficacious than the mechanism of aspirin. The treatment with both should be for a year based on our guidelines. 6 months at the least. There is more and more evidence for long term treatment being even better ( 2 years or more). This does increase bleeding risk, particularly in the elderly. So the rusk- benefit Ratio needs to be weighed in each case. The other meds include a statin to prevent recurrence of atherosclerotic plaque in and around the stent ( inhibits plaque development and regressession ) .. also beta-blockers, particularly if the stent was placed for an acute MI (heart attack). The other main class are the ace inhibitors and angiotensin receptor blockers. Particularly in diabetics with heart disease or if there is scarring after the MI with diminished LV function and clinical heart failure. There are other classes of drugs that are used in certain clinical presentations ( aldosterone receptor blockers with significant MI/chf)