SurModics Inc (SRDX)

[DewDiligence]

Here’s an excerpt from Saturday’s WSJ about DES
vs BMS. It’s mostly a rehash of the stuff we’ve been
posting here for the past few days.

http://online.wsj.com/article/SB116559964246544769.html

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How Doctors Are Rethinking Drug-Coated Stents

By RON WINSLOW and ANNA WILDE MATHEWS
December 9, 2006

…"If you can't take [Plavix and aspirin] or if you can't pay for it, the bare-metal stent should be the chief option," said Robert Califf, head of Duke University's Duke Translational Medicine Institute in Durham, N.C. "That's abundantly clear."

It isn't clear how long patients need to stay on the drug to maintain protection against a clot, and there are other important concerns -- including the cost of the drug -- associated with its long-term use.

Kevin Graham, director of preventive cardiology at Minneapolis Heart Institute in Minnesota, said a patient in his practice stopped taking Plavix three-and-a-half years after getting a drug-coated stent and within a month, she had suffered a heart attack from a clot in the device.

A large observational study of nearly 4,700 patients, published online by the Journal of the American Medical Association this week, showed patients who got a drug-coated stent and stayed on Plavix had the lowest risk of death, heart attack or procedures to clear obstructed arteries, while those with the drug-coated stent who stopped taking the drug had the highest risk. Patients with bare-metal stents came in the middle.

While the study has limitations and isn't definitive, it is enough to convince Dr. Califf, its principal author, that patients with drug-coated stents should stay on the Plavix indefinitely -- or until additional research offers better guidance.

Brigham & Women's Dr. Cannon says there are four categories of patients who should consider bare-metal rather than drug-coated stents:

--People who have a history or risk of bleeding, such as ulcers or hemorrhages;

--People who aren't likely to be able to stay on Plavix indefinitely;

--People who can't afford the medicine; and

-- People who already take other blood thinners to manage an irregular heart-beat condition called atrial fibrillation.

Last week, John Brush, a cardiologist in private practice in Norfolk, Va., used a bare-metal stent to treat a heart-attack patient. A couple of months ago, he says, he would have put in a drug-coated device, "but I got subtle signals the patient was noncompliant."

…Another important issue is the need for other medical procedures. Dentists, surgeons and other doctors often ask patients to stop taking the blood thinner before undergoing dental surgery, colonoscopies or orthopedic procedures such as knee replacements. The University of Miami's Dr. O'Neill said he has had three patients end up in the emergency room with heart attacks because they temporarily stopped taking Plavix on the advice of other doctors.

"It's essential that patients not stop the Plavix unless they consult with the cardiologist that put the stent in," he said.

Etc.
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