Subacute occlusion, bleeding complications, hospital stay and restenosis after Palmaz-Schatz coronary stenting under a new antithrombotic regimen.
OBJECTIVE
This study was designed to evaluate the effect of an antithrombotic regimen without full early anticoagulation on subacute occlusion, bleeding, hospital stay and restenosis after elective coronary stenting.


BACKGROUND
Subacute occlusion is a major limitation of stenting. Aggressive antithrombotic therapy is not fully prophylactic against this complication, carries risk of bleeding, prolongs hospital stay and reduces cost-effectiveness.


METHODS
We studied 110 consecutive patients (121 lesions) who underwent elective Palmaz-Schatz stenting. Intravenous heparin was given only during the procedure. After stenting, patients took aspirin, dipyridamole, dextran, warfarin and low molecular weight heparin (enoxaparin, 40 mg subcutaneously daily, stopped when an international normalized ratio of 2 to 3 was achieved). The first 52 patients (group A) underwent coronary angiography 24 h after stenting, and hospital stay was extended until an international normalized ratio of 2 to 3.5 was achieved. The remaining 58 patients (group B) were discharged 24 h after stenting. Clinical and angiographic follow-up were performed 1 and 6 months after stenting for all patients.


RESULTS
In group A the activated partial thromboplastin time remained normal (30 +/- 6.2 s [mean +/- SD]) during enoxaparin administration, and hospital stay was 9.1 +/- 4.3 days. In group B hospital stay was 27 +/- 8 h. No major cardiac events occurred within the first month in patients from both groups. At 1 and 30 days all stented lesions remained patent. Only two patients (1.8%, 95% confidence interval [CI] 0.32% to 7%) developed bleeding. At 6 months, the restenosis rate was 22% (95% CI 15% to 30%).


CONCLUSIONS
After coronary stenting with optimal angiographic results, this new antithrombotic regimen prevented subacute stent occlusion and bleeding, with a brief hospital stay. No detrimental effect on the previously reported restenosis rate was observed.
Fernández-Avilés
F
F
Department of Cardiology, Hospital Universitario, Valladolid, Spain.
Alonso
J J
JJ
Durán
J M
JM
Gimeno
F
F
Muñoz
J C
JC
de la Fuente
L
L
San Román
J A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003911:Dextrans / Q000627:therapeutic use; D004176:Dipyridamole / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents / Q000009:adverse effects*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D003911:Dextrans; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D004176:Dipyridamole; D006493:Heparin; D001241:Aspirin