Coronary stenting in warfarin treated patients.
Dual antiplatelet therapy is standard treatment following coronary stent implantation. An important minority of patients also require chronic anticoagulation, most commonly for atrial fibrillation. There are no prospective trials to guide the selection of therapy in this situation. In this paper we review the available data and present practice recommendations. It appears that in patients who are not at high risk of bleeding, and in whom both coronary stenting and anticoagulation are considered necessary after careful consideration, drug eluting stents should be avoided as much as possible. Triple therapy with aspirin, clopidogrel and warfarin for one month, followed by the combination of aspirin and warfarin for life is the most reasonable approach.
Zahger
Doron
D
Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. dzahger@bgu.ac.il
Ilia
Reuben
R
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin