Reduction of thrombotic and hemorrhagic complications after stent implantation.
This study compared two consecutive antithrombotic strategies after Palmaz-Schatz stent implantation and involved 918 patients. Patients treated between May 1991 and May 1994 (group 1; n = 379) received aspirin, dipyridamole, and intravenous unfractionated heparin until oral anticoagulation was effective, between June 1994 and August 1995, 539 patients (group 2) were treated for 1 month with subcutaneous low-molecular-weight heparin (Fragmin), ticlopidine, and aspirin. There were no differences between the groups in terms of sex, clinical condition, vessel diameter, and severity and location of stenosis. Patients in group 1 were younger than those in group 2 (4% were > 70 years old compared with 12%, respectively; p < 0.01). Group 1 patients had more frequent unplanned stenting (48% vs 18%, respectively; p < 0.01) and fewer endoprostheses in the same artery than those in group 2 (1.1 +/- 0.5 vs 1.2 +/- 0.5, respectively; p < 0.01). Among group 2 patients, there was a significant reduction in thrombotic and hemorrhagic complications compared with group 1 patients. No subacute thrombosis occurred in patients in group 2 in contrast with a 5.8% incidence in patients in group 1 (p < 0.01). In addition, a lower incidence of groin and systemic bleeding was observed in patients in group 2 compared with patients in group 1 (2.6% vs 15%, respectively; p < 0.01). The association of low-molecular-weight heparin and antiplatelets provides a simpler antithrombotic strategy in patients treated with intracoronary stents and reduces the incidence of stent thrombosis and hemorrhagic complications. Our findings suggest that this antithrombotic regimen may prevent or completely avoid stent thrombosis.
Pan
M
M
Department of Cardiology, Hospital Reina Sofia, Cordoba, Spain.
Suárez de Lezo
J
J
Velasco
F
F
Romero
M
M
Medina
A
A
Segura
J
J
Hernández
E
E
Pavlovic
D
D
Melian
F
F
Gallardo
A
A
Zayas
R
R
Ruiz
M
M
Torres
A
A
D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000517:prevention & control*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D015607:Stents; D013988:Ticlopidine / Q000627:therapeutic use*; D013997:Time Factors
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine