title: Outcome of patients on oral anticoagulation undergoing coronary artery stenting: data from discharge to 12 months in the Warfarin and Coronary Stenting (WAR-STENT) Registry.
abstract: OBJECTIVE
  To obtain further, and more focused, information on the efficacy and safety of the antithrombotic regimens, including triple therapy (TT) of warfarin, aspirin, and clopidogrel; dual therapy (DT) of warfarin and single antiplatelet agent (aspirin or clopidogrel); and dual-antiplatelet therapy (DAPT) of aspirin and clopidogrel, prescribed to patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention with stent (PCI-S).
  
  
  BACKGROUND
  The true efficacy and safety of TT, DT, and DAPT in OAC patients undergoing PCI-S is largely undefined.
  
  
  METHODS
  We analyzed the database of the prospective, multicenter WARfarin and coronary STENTing (WAR-STENT) registry (ClinicalTrials.gov identifier NCT00722319), only including the post-discharge period.
  
  
  RESULTS
  Of the 401 patients discharged alive from index hospitalization, 339 (85%), 20 (5%), and 42 (10%) were prescribed TT, DT, and DAPT, respectively. Throughout a mean follow-up of 368.3 ± 22.8 days, major adverse cardiovascular events (MACE) (including cardiovascular death, myocardial infarction, repeat revascularization, stent thrombosis, and thromboembolism), total bleeding, major bleeding, and combination of MACE plus total bleeding were comparable across the three treatment groups. The absolute rate of major bleeding with TT was 4%. The antithrombotic treatment actually ongoing at major bleeding was TT in 44%, DT in 50%, and DAPT in 6% of cases.
  
  
  CONCLUSIONS
  In the real-world population of OAC patients undergoing PCI-S in the WAR-STENT registry, the three antithrombotic regimens of TT, DT, and DAPT showed comparable efficacy and safety. Due to several limitations, our data cannot be considered conclusive in confuting the current recommendations to prescribe TT. Further properly designed and sized studies are warranted.
authors.affiliation: Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Largo Nigrisoli 2, 40133 Bologna, Italy. andrearubboli@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi-Reggiani
authors.forename: Luigi
authors.initials: L
authors.lastname: Steffanon
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Andrea
authors.initials: A
authors.lastname: Rizzi
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Imperadore
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carosio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Steffenino
authors.forename: Marcello
authors.initials: M
authors.lastname: Galvani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
authors.forename: Luigi
authors.initials: L
authors.lastname: La Vecchia
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
mesh_terms: D000284:Administration, Oral; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use*; D000077144:Clopidogrel; D016206:Databases, Bibliographic; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D011446:Prospective Studies; D012042:Registries; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin