[Subacute thrombosis with antiplatelet treatment in a non-selected population of intracoronary stents: incidence and predictors].
BACKGROUND
After coronary stenting, the incidence of subacute stent thrombosis have been reduced to 0% using aspirin and ticlopidine, in studies with selected populations and intracoronary ultrasounds.


OBJECTIVE
To evaluate the incidence and predictors of subacute stent thrombosis in a nonselected population, using antithrombotic therapy.


METHODS
We studied 285 stents, consecutively and successfully implanted in 268 lesions of 226 patients. We used high pressure balloon inflation without intracoronary ultrasound. Post-stenting protocol included aspirin and ticlopidine during four weeks with no anticoagulation. We defined subacute stent thrombosis as death, acute myocardial infarction myocardial infarction or angiographic occlusion of stent, with TIMI flow 0-1, after the first 24 hours and during the first month.


RESULTS
Four patients presented events (1.7%): Three nonfatal myocardial infarction after discharge, with documented angiographic thrombosis of stent, and one death due to in-hospital myocardial infarction. All three non-fatal AMI, occurred in vessels less than 3 mm (p = 0.07) and in patients taking aspirin without ticlopidine (p < 0.001). After discharge, three (17%) of 18 patients with inadvertent discontinuation of ticlopidine presented subacute stent thrombosis, in contrast to none of 25 patients taking ticlopidine without aspirin. Excluded patients with discontinuation of ticlopidine, the incidence of subacute stent thrombosis was 0.5%.


CONCLUSIONS
After intracoronary stenting in a nonselected population, using antithrombotic treatment with aspirin and ticlopidine, we may expect a rate of subacute stent thrombosis about 1%. Ticlopidine seems to have the main role in preventing subacute stent thrombosis, above all in predisposing circumstances as small vessels.
Pascual Figal
D A
DA
Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia.
Valdés Chávarri
M
M
Ruipérez
J A
JA
Cortés
R
R
López Pálop
R
R
Picó Aracil
F
F
García Alberola
A
A
D000208:Acute Disease; D001241:Aspirin / Q000627:therapeutic use*; D003328:Coronary Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects*; D013988:Ticlopidine / Q000627:therapeutic use*
D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D001241:Aspirin