[Care of patients after coronary stent implantation: what is important in practice?].

The introduction of Drug Eluting Stents was an important step to reduce restenosis rate after coronary stent implantation. Unfortunately, reduction of restenosis was paid off by the price of potential increased late (>30 days) stent thrombosis. However, current data are not completely conclusive with respect to extent and duration of stent thrombosis and cardiovascular risk after drug eluting stent implantation. Until now, especially for patients at risk for stent thrombosis a prolonged (12 instead of 6 months) dual antiplatelet therapy with aspirin and clopidogrel is recommended. Thereby, the quality of physician instructions is predictive for patient's compliance. Premature termination of dual antiplatelet therapy should be avoided; many small surgical interventions (e.g. tooth extraction) can be performed under dual antiplatelet therapy. Patients with "triple therapy" (aspirin, clopidogrel and coumarin derivate) should be monitored carefully, since they have an excessive bleeding risk. An elective coronary angiography after coronary stent implantation is not routinely necessary. However in selected high-risk patients (e.g. left main or multivessel stent implantation) control angiography may be useful. Medical therapy of risk factors (hyperlipidemia, hypertension, and diabetes mellitus) is essential also after coronary stent implantation. It is important to screen patients for diabetes mellitus, since approximately 1/3 of patients after coronary intervention have an otherwise unrecognized diabetes mellitus or glucose tolerance disturbance.