This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JACC Interventions Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rogacka, R. Articles by Colombo, A. Search for Related Content PubMed Articles by Rogacka, R. Articles by Colombo, A.

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

Related articles in JACC Interventions:

Dual Antiplatelet and Oral Anticoagulant Therapy: Increasing Use and Precautions for a Hazardous Combination

Elaine M. Hylek and David E. Solarz
JACC Interventions 2008 1: 62-64. [Full Text]  

This article has been cited by other articles:

				J. P. Piccini, A. F. Hernandez, X. Zhao, M. R. Patel, W. R. Lewis, E. D. Peterson, G. C. Fonarow, and Get With The Guidelines Steering Committee and Hos Quality of care for atrial fibrillation among patients hospitalized for heart failure. J. Am. Coll. Cardiol., September 29, 2009; 54(14): 1280 - 1289. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr, D. J. Kereiakes, N. S. Kleiman, D. J. Moliterno, G. Patti, and C. L. Grines Combining Antiplatelet and Anticoagulant Therapies. J. Am. Coll. Cardiol., July 7, 2009; 54(2): 95 - 109. [Abstract] [Full Text] [PDF]

				A. Sourgounis, J. Lipiecki, T. S. Lo, and M. Hamon Coronary Stents and Chronic Anticoagulation Circulation, March 31, 2009; 119(12): 1682 - 1688. [Full Text] [PDF]

				Hazards of Warfarin Plus Antiplatelet Therapy Journal Watch (General), June 26, 2008; 2008(626): 2 - 2. [Full Text]

				Risks of Combining Dual Antiplatelet Therapy with Warfarin Journal Watch Cardiology, June 4, 2008; 2008(604): 3 - 3. [Full Text]

				J. M. Ruiz-Nodar, F. Marin, and G. Y.H. Lip Antithrombotic Therapy Use After Percutaneous Coronary Intervention and Stent Implantation in Patients Taking Chronic Oral Anticoagulation J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 329 - 329. [Full Text] [PDF]

				G. R. Giugliano and A. S. Lotfi Dual Antiplatelet Therapy Plus Oral Anticoagulation: How Does Hemorrhagic Risk Impact Stent Selection? J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 330 - 330. [Full Text] [PDF]

				R. Rogacka, A. Chieffo, and A. Colombo Reply J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 330 - 331. [Full Text] [PDF]

				E. M. Hylek and D. E. Solarz Dual antiplatelet and oral anticoagulant therapy increasing use and precautions for a hazardous combination. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 62 - 64. [Full Text] [PDF]