Therapeutic strategies after coronary stenting in chronically anticoagulated patients: the MUSICA study.
OBJECTIVE
To identify the therapeutic regimens used at discharge in patients receiving oral anticoagulant therapy (OAT) who undergo stenting percutaneous coronary intervention and stent implantation (PCI-S), and to assess the safety and efficacy associated with different therapeutic regimens according to thromboembolic risk.


METHODS
A prospective multicentre registry.


METHODS
In hospital, after discharge and follow-up by telephone call.


METHODS
405 patients (328 male/77 female; mean (SD) age 71 (9) years) receiving OAT who underwent PCI-S between November 2003 and June 2006 from nine catheterisation laboratories of tertiary care teaching hospitals in Spain and one in the United Kingdom were included.


RESULTS
Three therapeutic regimens were identified at discharge: triple therapy (TT) -- that is, any anticoagulant (AC) plus double antiplatelet therapy (DAT; 278 patients (68.6%); AC and a single antiplatelet (AC+AT; 46 (11.4%)) and DAT only (81 (20%)). At 6 months, patients receiving TT showed the greatest rate of bleeding events. No patients receiving DAT at low thromboembolic risk presented a bleeding event (14.8% receiving TT, 11.8% receiving AC+AT and 0% receiving DAT, p = 0.033) or cardiovascular event (6.7% receiving TT, 0% receiving AC+AT and 0% receiving DAT, p = 0.126). The combination of AC+AT showed the worst rate of adverse events in the whole cohort, especially in patients at moderate-high thromboembolic risk.


CONCLUSIONS
In patients receiving OAT, TT was the most commonly used regimen after PCI-S. DAT was associated with the lowest rate of bleeding events and a similar efficacy to TT in patients at low thromboembolic risk. TT should probably be restricted to patients at moderate-high thromboembolic risk.
Sambola
A
A
Area del Cor Hospital, Universitari Vall d'Hebron, Barcelona, Spain.
Ferreira-González
I
I
Angel
J
J
Alfonso
F
F
Maristany
J
J
Rodríguez
O
O
Bueno
H
H
López-Minguez
J R
JR
Zueco
J
J
Fernández-Avilés
F
F
San Román
A
A
Prendergast
B
B
Mainar
V
V
García-Dorado
D
D
Tornos
P
P
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use*; D002908:Chronic Disease; D000077144:Clopidogrel; D003327:Coronary Disease / Q000628:therapy*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D013923:Thromboembolism / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine