$4 Sale

Wal-Mart and Target recently announced the decision to start selling several generic drugs at a low price.
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For the Safety of Your Children

Once in a while we hear about a young healthy person dying on the playground. If you have a young budding star in the family, I am sure you have wondered how to assure the safety of your children engaged in competitive sports. Some of the common causes of sudden cardiac death in young healthy persons are long QT syndrome, hypertrophic cardiomyopathy and some other uncommon heart abnormalities. Quite a few of these problems can be diagnosed by two simple tests called EKG and echocardiogram. Countries like Japan mandate EKG for school going children of certain ages.
NBA recently became the first league to begin standardized cardiac screening
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New Stents: Did We Celebrate Too Early?

The news of FDA approval of drug-coated stents in April 2003 was received with great enthusiasm. These stents were expected to fail much less often as compared to the older stents that came to be called as bare metal stents.
The stent is a mesh like structure that is used to open the blockages in the heart arteries. The stents were a great improvement upon balloon angioplasty, where only a balloon was used to open blocked heart arteries. However, one in four or five stents would tend to block after deployment in the heart arteries. This is called stent stenosis, which is caused by scar formation. A long search for solution for the problem of stent stenosis lead to the invention of drug-coated stents. These stents have a polymer coating that is impregnated with a special chemical that is supposed to prevent scar formation, hence prevent stenosis. Initial data showed that stent stenosis rate for drug-coated stents was negligible as compared to 20-25% with older stents. That was a great cause for celebration. The post marketing data on drug-coated stents suggests stent stenosis rate of less than 10%. The drug-coated stents looked like a great idea till problem of late stent thrombosis was noticed.
When a stent is placed in the heart artery, the person’s cells cover it over some time. The older stents were covered quickly over few weeks after deployment. The new drug-coated stents, it turns out, don’t get covered that fast. This puts them at a high risk for clot formation for a long period after deployment. This clot formation called stent thrombosis can be fatal.

Reports of this problem with new stents have raised several questions:

1.Should we really always prefer drug-eluting stents to the older stents whenever we can (like we have done since April 2003)? After all, in addition to the complications, new stents are also much more expensive than the older ones.
2.One of the ideas is that using blood thinner Plavix for a longer period may help deal with the problem of late stent thrombosis. When we are making decision between new versus old stents, we will have to take extra expense of longer usage of Plavix into account too.
3.The detection of late stent thrombosis problem is leading to more questions. Two articles were published in recent New England Journal of Medicine. These articles have tried to answer the question whether new stents are superior to older stents in case of patients who come with heart attack. There is no clear winner as per these articles.

More studies are being done to see if new stents are better suited for certain special situations as opposed to being the preferred choice in all situations.

Here are the actions points for now:

1.We need to follow this very closely. I think more studies are going to be done. We need to see if more studies are going to vindicate new stents or are going to restrict the usage of new stents to certain niche indications.
2.The use of Plavix and aspirin for a prolonged period is more important than with older stents. Your provider should decide the exact duration. Whether prolonged use of Plavix is the perfect answer to this problem of late stent thrombosis is yet to be seen
3.If you already have a stent, these stents are not removable. Once deployed, they become part of your body.
4.If you are about to have a stent, it is a good idea to know if you have older bare metal stent or new drug coated stent.

Watch below how a stent is deployed:


To access my other article on drug-coated stents, click here
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