title: Dual antiplatelet therapy after percutaneous coronary intervention with stent implantation in patients taking chronic oral anticoagulation.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the safety of dual antiplatelet therapy in patients in whom long-term anticoagulation (AC) with warfarin is recommended.
  
  
  BACKGROUND
  The optimal antithrombotic strategy after percutaneous coronary intervention (PCI) for patients receiving AC is unclear.
  
  
  METHODS
  Consecutive patients who underwent stent implantation and were discharged on triple therapy (defined as the combination of aspirin and thienopyridines and AC) were analyzed.
  
  
  RESULTS
  Of the 127 patients with 224 lesions, 86.6% were men, with a mean age of 69.9 +/- 8.8 years. Drug-eluting stents (DES) were positioned in 71 (55.9%), and bare-metal stents (BMS) were positioned in 56 (44.1%) patients. Atrial fibrillation (AF) was the main indication (59.1%) for AC treatment. The mean triple therapy duration was 5.6 +/- 4.6 months, and clinical follow-up was 21.0 +/- 19.8 months. During the triple therapy period, 6 patients (4.7%) developed major bleeding complications; 67% occurred within the first month. No significant differences between DES and BMS were observed in the incidence of major (5.6% vs. 3.6%, respectively, p = 1.0) and minor (1.4% vs. 3.6%, respectively, p = 0.57) bleeding and mortality (5.6% vs. 1.8%, respectively, p = 0.39). A significant difference was observed in favor of DES in target vessel revascularization (14.1% vs. 26.8%, p = 0.041).
  
  
  CONCLUSIONS
  While receiving triple therapy, major bleeding occurred in 4.7% of patients; one-half of the events were lethal, and most occurred within the first month.
authors.affiliation: San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Rogacka
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Castelli
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Valeria
authors.initials: V
authors.lastname: Magni
authors.forename: Tiziana C
authors.initials: TC
authors.lastname: Aranzulla
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin