Optimal antithrombotic treatment in patients with an indication for long-term anticoagulation undergoing coronary artery stenting.
Dual antiplatelet treatment with aspirin and either ticlopidine or clopidogrel is recommended after percutaneous coronary intervention with stent implantation (PCI-S). However, in patients with an indication for oral anticoagulation (OAC) undergoing PCI-S with an indication for long-term OAC--because of atrial fibrillation, mechanical heart valve or previous thromboembolism--the optimal antithrombotic treatment is unknown. The limited evidence available shows substantial variability in the management of these patients, for whom the adopted strategies include substitution of OAC for dual antiplatelet therapy, addition of a single antiplatelet agent to OAC and institution of triple therapy with OAC, aspirin and a thienopyridine. Both the efficacy and safety of the various regimens appear suboptimal, with a 30-day occurrence of thrombotic and major bleeding complications of 4 and 3-7%, respectively. Large-scale registries and clinical trials are warranted to determine the optimal antithrombotic treatment in these patients whose number is likely to progressively increase over the coming years. In the meantime, periprocedural, medium- and long-term antithrombotic treatment should be based on accurate risk stratification of thrombo(embolic) complications.
Maggiore Hospital, Largo Nigrisoli 2, Division of Cardiology, 40133 Bologna, Italy. andrearubboli@libero.it
Andrea
A
Rubboli
Giuseppe
G
Di Pasquale