Antithrombotic strategies in patients with an indication for long-term anticoagulation undergoing coronary artery stenting: safety and efficacy data from a single center.

BACKGROUND: Dual antiplatelet therapy is the antithrombotic treatment generally recommended after percutaneous coronary intervention with stent implantation (PCI-S). However, the optimal antithrombotic treatment after PCI-S in case of a concomitant indication for anticoagulation (AC) is unknown. The aim of our study was to determine the strategies adopted at our Institution (where the management of these patients is at the physician's discretion), and to evaluate their relative efficacy and safety. METHODS: A retrospective analysis of all PCI-S performed between January 2002-April 2004, was carried out. All patients on AC at the time of PCI-S were identified and the hemorrhagic and thromboembolic complications recorded. RESULTS: Twenty-seven patients (21 males, 6 females, mean age 66.9 +/- 10.6 years) on AC because of atrial fibrillation, post-myocardial infarction cardiomyopathy, left ventricular or arterial thrombus, previous cerebrovascular event, and mechanical aortic or mitral valve, were identified. The adopted antithrombotic treatment included: dual antiplatelet therapy in 6 patients (22%), a combination of a single antiplatelet with either aspirin or a thienopyridine and oral AC in 5 (19%), and triple therapy with dual antiplatelet and either oral AC or low-molecular-weight heparin administration in 16 (59%). The overall complication rate at 32.3 +/- 5.4 days was 18%, accounted for by two in-hospital major hemorrhages requiring blood transfusion (7%), two minor hemorrhages treated conservatively (7%), and one subacute stent thrombosis requiring emergency percutaneous reintervention (4%). CONCLUSIONS: At our Institution, variable antithrombotic strategies are adopted after PCI-S in patients with an indication for AC. Since the overall complication rate was relevant, further properly sized and designed studies are warranted in order to identify the optimal antithrombotic treatment in this patient subset.