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Dual Antiplatelet Therapy After Percutaneous Coronary Intervention With Stent Implantation in Patients Taking Chronic Oral Anticoagulation

San Raffaele Scientific Institute and Emo Centro Cuore Columbus, Milan, Italy.

^_* Reprint requests and correspondence: Dr. Antonio Colombo, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. (Email: colombo.antonio{at}hsr.it).

Objectives: The purpose of this study was to evaluate the safety of dual antiplatelet therapy in patients in whom long-term anticoagulation (AC) with warfarin is recommended.

Background: The optimal antithrombotic strategy after percutaneous coronary intervention (PCI) for patients receiving AC is unclear.

Methods: Consecutive patients who underwent stent implantation and were discharged on triple therapy (defined as the combination of aspirin and thienopyridines and AC) were analyzed.

Results: Of the 127 patients with 224 lesions, 86.6% were men, with a mean age of 69.9 ± 8.8 years. Drug-eluting stents (DES) were positioned in 71 (55.9%), and bare-metal stents (BMS) were positioned in 56 (44.1%) patients. Atrial fibrillation (AF) was the main indication (59.1%) for AC treatment. The mean triple therapy duration was 5.6 ± 4.6 months, and clinical follow-up was 21.0 ± 19.8 months. During the triple therapy period, 6 patients (4.7%) developed major bleeding complications; 67% occurred within the first month. No significant differences between DES and BMS were observed in the incidence of major (5.6% vs. 3.6%, respectively, p = 1.0) and minor (1.4% vs. 3.6%, respectively, p = 0.57) bleeding and mortality (5.6% vs. 1.8%, respectively, p = 0.39). A significant difference was observed in favor of DES in target vessel revascularization (14.1% vs. 26.8%, p = 0.041).

Conclusions: While receiving triple therapy, major bleeding occurred in 4.7% of patients; one-half of the events were lethal, and most occurred within the first month.

Abbreviations and Acronyms   AC = anticoagulation   AF = atrial fibrillation   BMS = bare-metal stent(s)   INR = international normalized ratio   MACCE = major adverse cardiac and cerebrovascular events   MI = myocardial infarction   PES = paclitaxel-eluting stent(s)   SES = sirolimus-eluting stent(s)   TLR = target lesion revascularization   TVR = target vessel revascularization

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