Antiplatelet Therapy in Patients With Anticoagulants Undergoing Percutaneous Coronary Stenting (from STENTIng and oral antiCOagulants [STENTICO])

We evaluated the safety and efficacy of dual antiplatelet therapy, in association with oral anticoagulant (OAC) therapy, in patients undergoing percutaneous coronary intervention (PCI). The use of this triple therapy increases the rate of adverse outcomes, as shown by retrospective studies. In this...

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Bibliographic Details
Published in:The American journal of cardiology 2009-08, Vol.104 (3), p.338-342
Main Authors: Gilard, Martine, MD, Blanchard, Didier, MD, Helft, Gérard, MD, Carrier, Didier, MD, Eltchaninoff, Helene, MD, Belle, Loic, MD, Finet, Gérard, MD, Le Breton, Hervé, MD, Boschat, Jacques, MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary
Anticoagulants
Anticoagulants - pharmacology
Bioengineering
Biological and medical sciences
Blood clots
Cardiology
Cardiology and cardiovascular system
Cardiology. Vascular system
Cardiovascular
Computer Science
Coronary Artery Disease
Coronary Artery Disease - drug therapy
Coronary Artery Disease - therapy
Coronary heart disease
Coronary vessels
Diseases of the cardiovascular system
Drug Therapy, Combination
Drug-Eluting Stents
Engineering Sciences
Female
Heart
Hemorrhage
Hemorrhage - chemically induced
Human health and pathology
Humans
Life Sciences
Male
Medical sciences
Medical treatment
Platelet Aggregation Inhibitors
Platelet Aggregation Inhibitors - pharmacology
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Signal and Image processing
Stents
Time Factors
Treatment Outcome
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Summary:We evaluated the safety and efficacy of dual antiplatelet therapy, in association with oral anticoagulant (OAC) therapy, in patients undergoing percutaneous coronary intervention (PCI). The use of this triple therapy increases the rate of adverse outcomes, as shown by retrospective studies. In this first prospective multicenter registry STENTIng and oral antiCOagulation (STENTICO), all patients with OAC therapy undergoing PCI were included and followed up at 2 and 12 months. A total of 359 patients were included from 40 French centers. In 234 (65.2%; group 1) of these 359 patients, OAC therapy was discontinued (22 ± 31 days). In 125 patients (34.8%; group 2), triple therapy was continued. The baseline characteristics were similar in the 2 groups. In group 2, a radial approach was more often used (65.6% vs 43.8%, p = 0.003), fewer drug-eluting stents were implanted (33.3% vs 24.8%, p = 0.06), and fewer anti-glycoprotein IIb/IIIa antagonists were prescribed (5.6% vs 8.5%, p = 0.02). The stroke rate did not differ significantly, at 3.0% (95% confidence interval 0.8% to 5.2%) for group 1 versus 0.8% (95% confidence interval −0.8% to 2.4%) in group 2. Severe and moderate bleeding, according to the Global Use of Strategies to Open Coronary Arteries (GUSTO) criteria, occurred in 2.1% and 6.4% of groups 1 and 2, respectively (p = 0.04). A significant difference in bleeding risk was found between the femoral and radial approaches (10.3% vs 3.8%, respectively; p = 0.01). In conclusion, adding dual antiplatelet therapy to pre-existing OAC therapy increases the post-PCI bleeding risk. Temporary discontinuation decreased this bleeding risk but tended to increase the risk of stroke. A radial approach for PCI could be a good alternative to the conventional femoral route to avoid bleeding.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2009.03.053