Antithrombotic Management and 1-Year Outcome of Patients on Oral Anticoagulation Undergoing Coronary Stent Implantation (from the Registro Regionale Angioplastiche Emilia-Romagna Registry)

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• 作者：Andrea Rubboli ; MD^a ; ^{andrearubboli@libero.it} ; Paolo Magnavacchi ; MD^b ; Paolo Guastaroba ; MSc^c ; Francesco Saia ; MD^d ; Luigi Vignali ; MD^e ; Paola Giacometti ; MD^f ; Nicoletta Franco ; MD^g ; Alberto Benassi ; MD^h ; Elisabetta Varani ; MDⁱ ; Gianluca Campo ; MD^j ; Antonio Manari ; MD^f ; Rossana De Palma ; MD^c ; Antonio Marzocchi ; MD^d
• 刊名：The American Journal of Cardiology
• 出版年：2012
• 出版时间：15 May, 2012
• 年：2012
• 卷：109
• 期：10
• 页码：1411-1417
• 全文大小：1167 K

文摘

Current recommendations for the antithrombotic management of patients receiving oral anticoagulation (OAC) who undergo percutaneous coronary intervention with stent implantation (PCI-S) are based on limited and relatively weak data. To broaden and strengthen available evidence, the management and 1-year outcomes of OAC patients who underwent PCI-S and were included in a prospective, multicenter registry from 2003 to 2007 were evaluated. Among the 632 patients receiving OAC, mostly because of atrial fibrillation (58 % ), who underwent PCI-S, mostly because of acute coronary syndromes (63 % ), dual-antiplatelet therapy with aspirin and clopidogrel was the most frequently prescribed at discharge (48 % ), followed by triple therapy with OAC, aspirin, and clopidogrel (32 % ) and OAC plus aspirin (18 % ). The choice of antithrombotic therapy largely matched the thromboembolic risk profiles of patients, with the prescription of regimens including OAC predicted by the presence of non-low-risk features. The cumulative 1-year occurrence of major adverse cardiovascular events was as high as 27 % and was not significantly different among the 3 treatment groups. Stroke and stent thrombosis were limited to 2 % and 3 % , respectively, and although no significant differences were found among the 3 groups, stroke was 4 times less frequent when OAC, with either 1 or 2 antiplatelet agents, was administered. Major bleeding was also limited to 3 % , with no significant differences among the 3 groups. In conclusion, these findings suggest overall real-world management of OAC patients who undergo PCI-S that is in accordance with their clinical risk profiles and give further support to the reported efficacy and safety of triple therapy for the optimal treatment of these patients.