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Minerva Cardioangiologica 2006 October;54(5):687-93

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Contemporary antithrombotic treatment after coronary stenting in patients with indication for long-term anticoagulation

Rubboli A. ¹, Brancaleoni R. ², Colletta M. ¹, Herzfeld J. ³, Sangiorgio P. ¹, Di Pasquale G. ¹

¹ Division of Cardiology Ospedale Maggiore, Bologna, Italy 2 Division of Internal Medicine General Hospital Porretta Terme, Bologna, Italy 3 School of Medicine Karolinska University, Stockholm, Sweden

Aim. Dual antiplatelet treatment with aspirin and a thienopyridine is the antithrombotic treatment recommended after percutaneous coronary intervention with stent implantation (PCI-S). Optimal treatment in patients with an indication for long-term oral anticoagulation (OAC) undergoing PCI-S is currently undefined. The aim of this study was to evaluate the contemporary management of these patients, and determine the safety and the efficacy of the various regimens.
Methods. A systematic review of the literature reporting on this issue was carried out.
Results. The adopted strategies showed substantial variability, and the regimens used included: substitution of OAC for dual antiplatelet therapy in 25-54% of cases, addition to OAC of a single antiplatelet agent in 12-25% and institution of triple therapy with OAC (or low-molecular-weight heparin), aspirin and a thienopyridine in about 60%. OAC was systematically aimed at a lower intensity in 33% of cases, whereas in another 29% this was pursued only when a high hemorrhagic risk was perceived. Both safety and efficacy of the various regimens appeared suboptimal, with a 30-day occurrence of major bleeding and thrombotic complications of 3-7% and 4%, respectively.
Conclusions. Due to the suboptimal safety and/or efficacy of the various regimens adopted, the optimal antithrombotic treatment in patients with an indication for OAC undergoing PCI-S remains to be defined. Since the number of this patient subgroup is foreseen to progressively increase over the next years, large scale registries and clinical trials are warranted.