Contemporary antithrombotic treatment after coronary stenting in patients with indication for long-term anticoagulation.
OBJECTIVE
Dual antiplatelet treatment with aspirin and a thienopyridine is the antithrombotic treatment recommended after percutaneous coronary intervention with stent implantation (PCI-S). Optimal treatment in patients with an indication for long-term oral anticoagulation (OAC) undergoing PCI-S is currently undefined. The aim of this study was to evaluate the contemporary management of these patients, and determine the safety and the efficacy of the various regimens.


METHODS
A systematic review of the literature reporting on this issue was carried out.


RESULTS
The adopted strategies showed substantial variability, and the regimens used included: substitution of OAC for dual antiplatelet therapy in 25-54% of cases, addition to OAC of a single antiplatelet agent in 12-25% and institution of triple therapy with OAC (or low-molecular-weight heparin), aspirin and a thienopyridine in about 60%. OAC was systematically aimed at a lower intensity in 33% of cases, whereas in another 29% this was pursued only when a high hemorrhagic risk was perceived. Both safety and efficacy of the various regimens appeared suboptimal, with a 30-day occurrence of major bleeding and thrombotic complications of 3-7% and 4%, respectively.


CONCLUSIONS
Due to the suboptimal safety and/or efficacy of the various regimens adopted, the optimal antithrombotic treatment in patients with an indication for OAC undergoing PCI-S remains to be defined. Since the number of this patient subgroup is foreseen to progressively increase over the next years, large scale registries and clinical trials are warranted.
Rubboli
A
A
Division of Cardiology, Ospedale Maggiore, Largo Nigrisoli 2, 40133 Bologna, Italy. andrearubboli@libero.it
Brancaleoni
R
R
Colletta
M
M
Herzfeld
J
J
Sangiorgio
P
P
Di Pasquale
G
G
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015607:Stents; D013997:Time Factors
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors