title: In-hospital management and outcome of patients on warfarin undergoing coronary stent implantation: results of the multicenter, prospective WARfarin and coronary STENTing (WAR-STENT) registry.
abstract: The in-hospital management of patients on warfarin undergoing coronary stent implantation (PCI-S) is variable, and the in-hospital outcome incompletely defined. To determine the adherence to the current recommendations, and the incidence of adverse events, we carried out the prospective, multicenter, observational WARfarin and coronary STENTing (WAR-STENT) registry (ClinicalTrials.gov identifier NCT00722319). All consecutive patients on warfarin undergoing PCI-S at 37 Italian centers were enrolled and followed for 12 months. Outcome measures were: major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, need for urgent revascularization, stroke, and venous thromboembolism, and major and minor bleeding. In this paper, we report the in-hospital findings. Out of the 411 patients enrolled, 92% were at non-low (ie, moderate or high) thromboembolic risk. The radial approach and bare-metal stents were used in 61% and 60% of cases, respectively. Drug-eluting stents were essentially reserved to patients with diabetes, which in turn, significantly predicted the implantation of drug-eluting stents (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.29-3.17; P=.002). The in-hospital MACE and major bleeding rates were 2.7% and 2.1%, respectively. At discharge, triple therapy (TT) of warfarin, aspirin, and clopidogrel was prescribed to 76% of patients. Prescription of TT was significantly more frequent in the non-low thromboembolic risk group. Non-low thromboembolic risk, in turn, was a significant predictor of TT prescription (OR, 11.2; 95% CI, 4.83-26.3; P<.0001). In conclusion, real-world warfarin patients undergoing PCI-S are largely managed according to the current recommendations. As a consequence, the risk of in-hospital MACE and major bleedings appears limited and acceptable.
authors.affiliation: Unità Operativa di Cardiologia, Laboratorio di Cardiologia Interventistica, Ospedale Maggiore, Bologna, Italy. andrearubboli@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Luigi Andrea
authors.initials: LA
authors.lastname: Moroni
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Franco
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Varani
authors.forename: Michela
authors.initials: M
authors.lastname: Santi
authors.forename: Paola
authors.initials: P
authors.lastname: Pasqualini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capecchi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Piccalò
authors.forename: Massimo
authors.initials: M
authors.lastname: Margheri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: di Pasquale
authors.forename: Marcello
authors.initials: M
authors.lastname: Galvani
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D019468:Disease Management; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000453:epidemiology; D013923:Thromboembolism / Q000453:epidemiology; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin