title: Adequate antiplatelet regimen in patients on chronic anti-vitamin K treatment undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  To investigate the impact of dual antiplatelet therapy (DAT) in patients on anti-vitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).
  
  
  METHODS
  Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug eluting stent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was defined according to type of stent implanted and to its clinical indication.
  
  
  RESULTS
  The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02).
  
  
  CONCLUSIONS
  Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes.
authors: Salvatore Brugaletta, Victoria Martin-Yuste, Luis Alvarez-Contreras, Manel Sabaté, Thorax Institute, Department of Cardiology, Hospital Clinic, 08036 Barcelona, Spain.
authors: Salvatore
authors: S
authors: Brugaletta
authors: Victoria
authors: V
authors: Martin-Yuste
authors: Ignacio
authors: I
authors: Ferreira-González
authors: Clarissa
authors: C
authors: Cola
authors: Luis
authors: L
authors: Alvarez-Contreras
authors: Marta De
authors: MD
authors: Antonio
authors: Xavier
authors: X
authors: Garcia-Moll
authors: Joan
authors: J
authors: García-Picart
authors: Vicens
authors: V
authors: Martí
authors: Jordi
authors: J
authors: Balcells-Iranzo
authors: Manel
authors: M
authors: Sabaté