title: Antithrombotic management and 1-year outcome of patients on oral anticoagulation undergoing coronary stent implantation (from the Registro Regionale Angioplastiche Emilia-Romagna Registry).
abstract: Current recommendations for the antithrombotic management of patients receiving oral anticoagulation (OAC) who undergo percutaneous coronary intervention with stent implantation (PCI-S) are based on limited and relatively weak data. To broaden and strengthen available evidence, the management and 1-year outcomes of OAC patients who underwent PCI-S and were included in a prospective, multicenter registry from 2003 to 2007 were evaluated. Among the 632 patients receiving OAC, mostly because of atrial fibrillation (58%), who underwent PCI-S, mostly because of acute coronary syndromes (63%), dual-antiplatelet therapy with aspirin and clopidogrel was the most frequently prescribed at discharge (48%), followed by triple therapy with OAC, aspirin, and clopidogrel (32%) and OAC plus aspirin (18%). The choice of antithrombotic therapy largely matched the thromboembolic risk profiles of patients, with the prescription of regimens including OAC predicted by the presence of non-low-risk features. The cumulative 1-year occurrence of major adverse cardiovascular events was as high as 27% and was not significantly different among the 3 treatment groups. Stroke and stent thrombosis were limited to 2% and 3%, respectively, and although no significant differences were found among the 3 groups, stroke was 4 times less frequent when OAC, with either 1 or 2 antiplatelet agents, was administered. Major bleeding was also limited to 3%, with no significant differences among the 3 groups. In conclusion, these findings suggest overall real-world management of OAC patients who undergo PCI-S that is in accordance with their clinical risk profiles and give further support to the reported efficacy and safety of triple therapy for the optimal treatment of these patients.
authors.affiliation: Division of Cardiology and Cardiac Catheterization Laboratory, Ospedale Maggiore, Bologna, Italy. andrearubboli@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Paolo
authors.initials: P
authors.lastname: Magnavacchi
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.forename: Paola
authors.initials: P
authors.lastname: Giacometti
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Franco
authors.forename: Alberto
authors.initials: A
authors.lastname: Benassi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Varani
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.forename: Antonio
authors.initials: A
authors.lastname: Manari
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents