Triple versus dual antiplatelet therapy after coronary stenting: impact on stent thrombosis.
OBJECTIVE
We evaluated safety and efficacy of triple antiplatelet therapy with aspirin, clopidogrel, or ticlopidine and cilostazol after coronary stenting.


BACKGROUND
Triple antiplatelet therapy might have beneficial effect to prevent thrombotic complications in patients undergoing coronary stenting.


METHODS
Patients undergoing successful coronary stenting were divided into dual antiplatelet therapy (aspirin plus clopidogrel or ticlopidine, group I, n = 1,597) and triple antiplatelet therapy (aspirin plus clopidogrel or ticlopidine plus cilostazol, group II, n = 1,415) groups. The primary end point included death, myocardial infarction, target lesion revascularization, or stent thrombosis within 30 days. The secondary end point was side effects of study drugs, including major bleeding, vascular complication, hepatic dysfunction, and hematological complications.


RESULTS
Multi-vessel stenting and the use of long stents were more prevalent in group II than in group I. The primary end point was 0.8% in group I and 0.3% in group II (p = 0.085). Stent thrombosis within 30 days was significantly lower in group II (n = 1, 0.1%) than in group I (n = 9, 0.5%; p = 0.024). The independent predictors of stent thrombosis were primary stenting (odds ratio [OR] 7.9, 95% confidence interval [CI] 2.0 to 30.8, p = 0.003) and triple therapy (OR 0.12, 95% CI 0.015 to 0.98, p = 0.048). The overall adverse drug effects, including major bleeding, neutropenia, and thrombocytopenia, were no different between two groups (1.8% vs. 2.6%, p = 0.104).


CONCLUSIONS
Compared with the dual antiplatelet regimen, triple antiplatelet therapy seemed to be more effective in preventing thrombotic complications after stenting without an increased risk of side effects. Triple antiplatelet therapy might be safely applied in patients or lesions with a high risk of stent thrombosis.
Lee
Seung-Whan
SW
Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Park
Seong-Wook
SW
Hong
Myeong-Ki
MK
Kim
Young-Hak
YH
Lee
Bong-Ki
BK
Song
Jong-Min
JM
Han
Ki Hoon
KH
Lee
Cheol Whan
CW
Kang
Duk-Hyun
DH
Song
Jae-Kwan
JK
Kim
Jae-Joong
JJ
Park
Seung-Jung
SJ
D001241:Aspirin / Q000008:administration & dosage*; D000077407:Cilostazol; D000077144:Clopidogrel; D003327:Coronary Disease / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects*; D013777:Tetrazoles / Q000008:administration & dosage*; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D000077144:Clopidogrel; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin