[Influence of various antithrombotic therapy methods on the incidence of subacute coronary stent occlusions, hemorrhagic complications and length of hospitalization].
BACKGROUND
The clinical benefit of coronary stenting is reduced by the risk of thrombotic stent occlusion as well as hemorrhagic complications of intensive antithrombotic therapy. We compared the influence of different antithrombotic therapies on the incidence of post-interventional complications and in-hospital stay duration.


METHODS
After successful placement of a coronary stent, 334 consecutive patients were given different antithrombotic treatments in addition to aspirin 100 mg/d indefinitely: (1) phenprocoumon for 3 months (n = 47), (2) low molecular weight heparin 2 x 100 U/kg/d s.c. for 4 weeks (n = 90), (3) ticlopidine 2 x 250 mg/d and low molecular weight heparin 2 x 100 U/kg/d s.c. for 4 weeks (n = 72) and (4) ticlopidine 2 x 250 mg/d for 4 weeks (n = 125).


RESULTS
Major events were subacute stent thrombosis in 17 patients (5%), and severe hemorrhagic complication in 20 patients (5.9%). The incidence of subacute stent thrombosis in groups 1 to 4 was 10.6%, 11%, 1.4% and 0.8% respectively. The use of ticlopidine was associated with a significant lowering of stent occlusions in univariate and multivariate analysis (p = 0.0013). Additional uni- and multivariate predictors were stent placement as a "bail-out" procedure (p = 0.033) and in patients with acute coronary syndrome (p = 0.049). Anticoagulant therapy was associated with a higher incidence of severe hemorrhagic complications (p < 0.01) and a prolonged in-hospital stay (p = 0.01).


CONCLUSIONS
These results confirm that anti-thrombotic therapy with aspirin and ticlopidine combines low rates of subacute stent occlusion and hemorrhagic complications. Treatment with phenprocoumon and low molecular weight heparin does not improve the rate of subacute stent occlusion but increases hemorrhagic complications. Very low rates of stent occlusion permit short in-hospital stays with concomitant reduction in cost.
Facchini
M
M
Abteilung Kardiologie, Universitätsspital Zürich.
Muntwyler
J
J
Schuiki
E
E
Rickli
H
H
Kiowski
W
W
Amann
F W
FW
D000208:Acute Disease; D003327:Coronary Disease / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000379:methods
Einfluss verschiedener antithrombotischer Therapien auf die Häufigkeit von subakuten koronaren Stentverschlüssen, Blutungskomplikationen und Hospitalisationsdauer.