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Antiplatelet therapy in patients with anticoagulants undergoing percutaneous coronary stenting (from STENTIng and oral antiCOagulants [STENTICO])
- Source :
- American Journal of Cardiology, American Journal of Cardiology, Elsevier, 2009, 104 (3), pp.338-42. ⟨10.1016/j.amjcard.2009.03.053⟩
- Publication Year :
- 2009
-
Abstract
- International audience; 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.
- Subjects :
- Male
Percutaneous
Time Factors
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
0302 clinical medicine
MESH: Aged, 80 and over
[INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing
030212 general & internal medicine
MESH: Coronary Artery Disease
Angioplasty, Balloon, Coronary
Stroke
MESH: Treatment Outcome
MESH: Aged
Aged, 80 and over
Anticoagulant
Drug-Eluting Stents
3. Good health
MESH: Angioplasty, Balloon, Coronary
Treatment Outcome
MESH: Platelet Aggregation Inhibitors
Anesthesia
[SDV.IB]Life Sciences [q-bio]/Bioengineering
Drug Therapy, Combination
Female
Cardiology and Cardiovascular Medicine
[SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing
MESH: Hemorrhage
MESH: Drug-Eluting Stents
medicine.medical_specialty
medicine.drug_class
Hemorrhage
MESH: Anticoagulants
03 medical and health sciences
Pharmacotherapy
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Angioplasty
medicine
Humans
Aged
MESH: Humans
business.industry
MESH: Time Factors
Percutaneous coronary intervention
Anticoagulants
medicine.disease
MESH: Male
Surgery
Discontinuation
MESH: Drug Therapy, Combination
Conventional PCI
business
MESH: Female
Platelet Aggregation Inhibitors
Subjects
Details
- ISSN :
- 18791913 and 00029149
- Volume :
- 104
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The American journal of cardiology
- Accession number :
- edsair.doi.dedup.....4dbf917ad6e8f2c2e71fc7ed42feed93