title: Coronary artery stents and antiplatelet therapy in patients with cirrhosis.
abstract: OBJECTIVE
  To describe our experience with coronary artery stenting and antiplatelet therapy in cirrhotic patients and compare rates of bleeding with a control group.
  
  
  BACKGROUND
  Although there are data on cardiac evaluation and perioperative cardiac risk in cirrhotic patients, there is a paucity of information on outcomes in cirrhotic patients with coronary artery stents. Cirrhotic patients may be at increased risk for complications, including gastrointestinal bleeding as a result of antiplatelet therapy prescribed after stenting.
  
  
  METHODS
  We performed a retrospective study of complications in cirrhotics that received a coronary artery stent followed by clopidogrel and aspirin prescribed to prevent stent occlusion. Cirrhotics with stents were compared with an age and sex-matched control group with cirrhosis without stents and not on aspirin.
  
  
  RESULTS
  Among 423 cirrhotic patients who underwent liver transplant evaluation, 16 patients (3.8%) received a stent of which 9 underwent liver transplant. Two patients with varices (12.5%) in the stent group had fatal variceal bleeding and 2 controls (6.3%) had nonfatal variceal bleeding during follow-up while on antiplatelet therapy (P=0.86). There were no significant differences in transfusion requirements between the 9 liver transplant recipients with stents compared with the control group, P=0.69 for packed red blood cells.
  
  
  CONCLUSIONS
  In our experience, it is safe for cirrhotic patients without varices to receive a coronary artery stent and for cirrhotic patients with coronary artery stents to be considered for liver transplantation. Larger prospective studies are needed to confirm these results and evaluate the risk of bleeding in cirrhotics with varices who receive coronary artery stents and antiplatelet therapy.
authors: Carolinas Medical Center, Transplant Center, Blythe Boulevard, Charlotte, NC 28203, USA. Mark.Russo@carolinashealthcare.org
authors: Mark W
authors: MW
authors: Russo
authors: John
authors: J
authors: Pierson
authors: Tarun
authors: T
authors: Narang
authors: Anna
authors: A
authors: Montegudo
authors: Lon
authors: L
authors: Eskind
authors: Sanjeev
authors: S
authors: Gulati
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000601:surgery*; D005234:Fatty Liver / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin