title: Long-term safety of drug-eluting stents in patients on warfarin treatment.
abstract: BACKGROUND
  The safety of drug-eluting stents (DES) in patients on long-term warfarin treatment has been questioned due to high risk of bleeding complications during prolonged triple (aspirin, clopidogrel, and warfarin) antithrombotic therapy.
  
  
  METHODS
  We analysed the long-term outcome of 415 consecutive warfarin-treated patients who underwent DES (n = 191) or bare-metal (n = 224) stenting in six hospitals.
  
  
  RESULTS
  The mean duration of triple therapy was longer (4.2 ± 3.1 versus 2.1 ± 1.8 months; P < 0.001) in the DES group. The incidence of major adverse cardiovascular and cerebrovascular events was comparable in the DES and bare-metal groups (39.8% versus 42.4%; P = 0.59) during a median follow-up of 3.5 years. Similarly, major bleeding events occurred equally often in both study groups (14.7% versus 12.9%). Six patients in the DES group and seven patients in the bare-metal group suffered stent thrombosis (3.1% versus 3.1%). In the propensity score analyses of 101 matched pairs, the outcome was similar in the two groups.
  
  
  CONCLUSIONS
  Selective use of DES with a short triple therapy seems to be safe in patients with warfarin therapy. The prognosis of this fragile patient population is quite poor, and major bleeding events are common irrespective of stent type.
authors.affiliation: Division of Internal Medicine, Department of Cardiology, Seinäjoki Central Hospital, Finland.
authors.forename: Antti-Pekka
authors.initials: AP
authors.lastname: Annala
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Karjalainen
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Antti
authors.initials: A
authors.lastname: Ylitalo
authors.forename: Saila
authors.initials: S
authors.lastname: Vikman
authors.forename: Pekka
authors.initials: P
authors.lastname: Porela
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D000075202:Contraindications; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D057216:Propensity Score; D015607:Stents; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin