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Volume 104, Issue 3, Pages 338-342 (1 August 2009)
Antiplatelet Therapy in Patients With Anticoagulants Undergoing Percutaneous Coronary Stenting (from STENTIng and oral antiCOagulants [STENTICO])
Martine Gilard, MD(a), Didier Blanchard, MD(b), Gérard Helft, MD(c), Didier Carrier, MD(d), Helene Eltchaninoff, MD(e), Loic Belle, MD(f), Gérard Finet, MD(h), Hervé Le Breton, MD(g), Jacques Boschat, MD(a), STENTICO Investigators
Received 2 January 2009; received in revised form 14 March 2009; accepted 14 March 2009. published online 05 June 2009.
We evaluated the safety and efficacy of dual antiplatelet therapy, in association with oral anticoagulant (OAC) therapy, in patients undergoing percutaneous coronary intervention (PCI). The use of this triple therapy increases the rate of adverse outcomes, as shown by retrospective studies. In this first prospective multicenter registry STENTIng and oral antiCOagulation (STENTICO), all patients with OAC therapy undergoing PCI were included and followed up at 2 and 12 months. A total of 359 patients were included from 40 French centers. In 234 (65.2%; group 1) of these 359 patients, OAC therapy was discontinued (22 ± 31 days). In 125 patients (34.8%; group 2), triple therapy was continued. The baseline characteristics were similar in the 2 groups. In group 2, a radial approach was more often used (65.6% vs 43.8%, p = 0.003), fewer drug-eluting stents were implanted (33.3% vs 24.8%, p = 0.06), and fewer anti-glycoprotein IIb/IIIa antagonists were prescribed (5.6% vs 8.5%, p = 0.02). The stroke rate did not differ significantly, at 3.0% (95% confidence interval 0.8% to 5.2%) for group 1 versus 0.8% (95% confidence interval −0.8% to 2.4%) in group 2. Severe and moderate bleeding, according to the Global Use of Strategies to Open Coronary Arteries (GUSTO) criteria, occurred in 2.1% and 6.4% of groups 1 and 2, respectively (p = 0.04). A significant difference in bleeding risk was found between the femoral and radial approaches (10.3% vs 3.8%, respectively; p = 0.01). In conclusion, adding dual antiplatelet therapy to pre-existing OAC therapy increases the post-PCI bleeding risk. Temporary discontinuation decreased this bleeding risk but tended to increase the risk of stroke. A radial approach for PCI could be a good alternative to the conventional femoral route to avoid bleeding.
(a) Department of Cardiology, University Hospital of Brest, Brest, France
(b) Department of Cardiology, Clinique St. Gatien, Tours, France
(c) Department of Cardiology, University Hospital of Paris, Paris, France
(d) Department of Cardiology, University Hospital of Toulouse, Toulouse, France
(e) Department of Cardiology, University Hospital of Rouen, Rouen, France
(f) Department of Cardiology, Hospital of Annecy, Annecy, France
(g) Department of Cardiology, University Hospital of Rennes, Rennes, France
(h) University Hospital of Lyon, Lyon, France
Corresponding author: Tel: (+33) 2-9834-7505; fax: (+33) 2-9805-3277
PII: S0002-9149(09)00815-7
doi:10.1016/j.amjcard.2009.03.053
© 2009 Elsevier Inc. All rights reserved.
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С Уважением,
Мальцев А.А.