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Once the procedure is completed, the patient will be transferred to a cardiac recovery room. He or she may feel groggy from the sedative. The catheter insertion site may be bruised and sore.
If the groin area was used as the point of catheter insertion, the patient will be instructed to lie in bed with legs out straight. The physician may choose to use one of two techniques for removing the sheath that was placed at the initiation of the procedure. The traditional technique is to wait until the effects of the anticoagulant have passed (four to six hours) and then to apply pressure while removing the sheath from the femoral artery. Another technique allows the sheath to be removed immediately after the procedure through the use of hemostatic devices that seal or stitch the femoral artery.
If the wrist or arm was used as the point of catheter insertion, the patient does not need to stay in bed. Throughout the post-procedure monitoring, the point of catheter entrance will be checked for bleeding, swelling or inflammation. Vital signs will be continuously monitored during this observation period. Usually, the patient will stay overnight for further observation.
During the first day or two after stenting, patients should drink plenty of fluids to prevent dehydration and help flush from the body the dye that was used during the procedure. Patients are also advised to avoid driving, bathing or smoking during this time.
Patients are given instructions from the medical staff regarding:
- Exercise and exertion. Patients are reminded to refrain from lifting heavy objects and engaging in strenuous exercise or sexual activity for 24 hours after the procedure.
- Care of the incision area. Bruising and soreness is possible and normal. Undue pain, swelling or inflammation may require medical attention.
- The function and use of medications and procedures. Patients will be prescribed medications (e.g., aspirin) to prevent the formation of blood clots (thrombosis) in the stent. These medications will be taken for life. Also, for one year following the procedure, patients will be prescribed an additional antiplatelet (clopidogrel) medication to minimize the risk of blood clot formation within the stent. Because of newer data showing that thrombosis risk among patients who received a drug-eluting stent rises after stopping clopidogrel, it is extremely important that patients take their medications exactly as prescribed, for the entire duration of the prescription.
Other medications that may be prescribed include anticoagulants and beta blockers, which have been shown to lower mortality in patients who have had a heart attack. In addition, statins, which are commonly used to lower cholesterol, may be prescribed. Studies show that statins improve the outcome for virtually all medically treated patients with coronary artery disease. Finally, in the first eight weeks after the procedure, patients will need to take antibiotics before any dental, medical or surgical procedures. Having an MRI (magnetic resonance imaging) is typically discouraged for up to six months after stent insertion, because within this time the stent may be moved by the magnetic field. |