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Antithrombotic management of patients on oral anticoagulation undergoing coronary artery stenting.

ABSTRACT: Patients on oral anticoagulation (OAC), who are referred for coronary artery stenting account for about 5% of the whole population undergoing percutaneous coronary intervention (PCI). Although relatively small, this patient subset poses particular problems owing to the need to balance carefully the risk of bleeding against the risk of stent thrombosis and thromboembolism. Triple therapy (TT) of OAC, aspirin and clopidogrel appears as the most effective for prevention of stent thrombosis and thromboembolism. However, an increased incidence of major bleeding is to be expected during follow-up. Therefore, TT should be prolonged for as short a time as possible, and implantation of drug-eluting stents avoided. Frequent monitoring of international normalized ratio is also warranted, and the intensity of OAC should be targeted at the lower limit of the therapeutic range. Gastric protection should also be considered for all patients on medium- to long-term TT, owing to the observed highest incidence of bleeding at the gastrointestinal site. Peri-procedural management is cumbersome, and a substantial incidence of in-hospital major bleeding has been reported. Since this latter is more related to procedural variables than to TT itself, choice of radial access, avoidance of glycoprotein IIb/IIIa inhibitors, and preference for not interrupting effective OAC should be implemented. However, the evidence on which the recommendations for managing this patient subset are based is limited and of relative poor quality. While waiting for the results of ongoing, large prospective studies that are aimed at conclusively determining optimal medium- to long-term antithrombotic treatment, the official recommendations issued by the Working Group on Thrombosis of the European Society of Cardiology on the management of patients on OAC undergoing PCI with stenting should followed.

SUBMITTER: Rubboli A

PROVIDER: S-EPMC2999026 | biostudies-other | 2010 Mar

REPOSITORIES: biostudies-other

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Antithrombotic management of patients on oral anticoagulation undergoing coronary artery stenting.

Rubboli Andrea A

World journal of cardiology 20100301 3

Patients on oral anticoagulation (OAC), who are referred for coronary artery stenting account for about 5% of the whole population undergoing percutaneous coronary intervention (PCI). Although relatively small, this patient subset poses particular problems owing to the need to balance carefully the risk of bleeding against the risk of stent thrombosis and thromboembolism. Triple therapy (TT) of OAC, aspirin and clopidogrel appears as the most effective for prevention of stent thrombosis and thro ...[more]

PMID: 21160758

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Project description:BACKGROUND:Most evidence regarding the efficacy and safety of the antithrombotic regimens for patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI-S) derives from small, single-center, retrospective datasets. To obtain further data on this issue, we carried out the prospective, multicenter, observational Management of patients with Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) registry (Clinicaltrials.gov identifier NCT00596570). HYPOTHESIS:We hypothesize that the antithrombotic treatment of AF patients undergoing PCI-S is variable and the clinical outcome may vary according to the different regimens. METHODS:Consecutive AF patients undergoing PCI-S at 17 European institutions were included and followed for 1 year. Outcome measures included: (1) major adverse cardiac/cerebrovascular events (MACCE), including all-cause death, myocardial infarction, repeat revascularization, stent thrombosis, or stroke/transient ischemic attack, and (2) bleeding, and were compared according to the antithrombotic regimen adopted. A propensity-score analysis was carried out to adjust for baseline and procedural differences. RESULTS:Out of the 975 patients enrolled, 914 were included in the final analysis. The mean CHADS2 score was 2.2 ± 1.2, and 71% of patients had a CHADS2 score ?2. Triple therapy (TT) of vitamin K antagonist (VKA), aspirin, and clopidogrel was prescribed to 74% of patients, dual antiplatelet therapy to 18%, and VKA plus clopidogrel to 8%. At 1-year follow-up, no significant differences were found in the occurrence of MACCE and bleeding among the 3 antithrombotic regimens, even when adjusted for propensity score. CONCLUSIONS:In this large, real-world population of AF patients undergoing PCI-S, TT was the antithrombotic regimen most frequently prescribed. Although several limitations need to be acknowledged, in our study the 1-year efficacy and safety of TT, dual antiplatelet therapy, and VKA plus clopidogrel was comparable.

Dataset Information

Antithrombotic management of patients on oral anticoagulation undergoing coronary artery stenting.

Publications

Antithrombotic management of patients on oral anticoagulation undergoing coronary artery stenting.

Similar Datasets

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