title: Twelve-month outcome of patients with an established indication for oral anticoagulation undergoing coronary artery stenting and stratified by the baseline risk of bleeding: Insights from the Warfarin and Coronary Stenting (War-Stent) Registry.
abstract: OBJECTIVE
  To evaluate the outcome of patients with an established indication for oral anticoagulation (OAC) undergoing coronary stent implantation (PCI-S) and stratified by the baseline risk of bleeding.
  
  
  METHODS
  The database of the prospective, multicentre, observational WAR-STENT registry (ClinicalTrials.gov identifier NCT00722319) was analyzed and patients with atrial fibrillation and CHA2DS2-VASc score ≥2, mechanical heart valve, prior cardiac embolism, intra-cardiac thrombus and recent venous thromboembolism who were treated with either triple (warfarin, aspirin and clopidogrel) or dual (warfarin and clopidogrel) or dual antiplatelet (aspirin and clopidogrel) therapy, identified. Patients were then sorted into two groups at non-low and low risk of bleeding, as defined by an ATRIA score >3 and ≤3 respectively, and compared regarding major adverse cardiac and vascular events (MACVE) and bleeding.
  
  
  RESULTS
  At 12-month follow up, MACVE were comparable in the two groups, whereas total, major and minor bleeding, as well as combined MACVE and total bleeding, were significantly more frequent in the non-low bleeding risk group. Upon Cox univariate and multivariable analysis, non-low bleeding risk category confirmed as an independent predictor of major bleeding. The choice of antithrombotic therapy however, appeared not to be influenced by the bleeding risk category at baseline.
  
  
  CONCLUSIONS
  In patients with an established indication for OAC undergoing PCI-S, non-low bleeding risk category is the most potent independent predictor of major bleeding. Stratification of the bleeding risk at baseline should therefore be regarded as an indispensable process to be carried out before selection of the antithrombotic therapy.
authors.affiliation: Division of Cardiology - Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy. Electronic address: andrearubboli@libero.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.affiliation: Cardio-Thoraco-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Unit of Interventional Cardiology, Ospedale Sandro Pertini, Roma, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.affiliation: Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Leone
authors.affiliation: Division of Interventional Cardiology, Ospedale del Cuore G. Pasquinucci, Massa, Italy.
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.affiliation: Cardio-Thoraco-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Bacchi-Reggiani
authors.affiliation: Division of Cardiology, Seconda Università, Ospedale Monaldi, Napoli, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.affiliation: Cardio-Thoraco-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bordoni
authors.affiliation: Division of Cardiology 1, Ospedale Niguarda, Milano, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Piccalò
authors.affiliation: Division of Cardiology, Ospedale degli Infermi, Rimini, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Franco
authors.affiliation: Division of Cardiology, Ospedale S. Corona, Pietra Ligure, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Nicolino
authors.affiliation: Division of Cardiology, Ospedale Civile S. Agostino Estense, Modena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Magnavacchi
authors.affiliation: Division of Cardiology, Azienda Ospedaliera-Universitaria, Parma, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Vignali
authors.affiliation: Division of Cardiology, Ospedale S. Francesco, Nuoro, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Mameli
authors.affiliation: Division of Cardiology, Ospedale S. Chiara, Trento, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Dallago
authors.affiliation: Division of Cardiology, Ospedale S. Leopoldo Mandic, Merate, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Maggiolini
authors.affiliation: Unit of Cardiac and Vascular interventions, Hesperia Hospital, Modena, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Steffanon
authors.affiliation: Division of Cardiology, Ospedale degli Infermi, Rimini, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Piovaccari
authors.affiliation: Division of Cardiology - Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012042:Registries; D015607:Stents / Q000009:adverse effects; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Oral anticoagulation; Percutaneous coronary intervention; Stent; Warfarin