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Aspirin and clopidogrel with or without phenprocoumon after drug eluting coronary stent placement in patients on chronic oral anticoagulation.
J Intern Med 2008; 264(5):472-80JI

Abstract

OBJECTIVES

Optimal antithrombotic/anticoagulation therapy in patients on chronic oral anticoagulation (OAC) undergoing drug-eluting stent (DES) implantation is unknown. We investigated the efficacy and safety of two regimens of antithrombotic/anticoagulation therapy in patients who present for DES implantation whilst on OAC.

METHODS

We included a series of 515 patients on OAC who underwent DES implantation between 2002 and 2007. Based on predefined clinical and echocardiographic criteria, 306 patients continued OAC (triple therapy) and 209 patients discontinued OAC (dual therapy) for the time they received antiplatelet therapy with clopidogrel and aspirin [stent-related antithrombotic treatment (SRAT)]. The primary end point was a composite of death, myocardial infarction, stent thrombosis or stroke.

RESULTS

During SRAT the primary endpoint was observed in 13 patients in the group with triple therapy versus 15 patients in the group with dual therapy [Kaplan-Meier estimates 4.2% and 7.2%, odds ratio (OR) = 0.61, 95% confidence interval (CI) 0.29-1.28; P = 0.19]. At 2 years of follow-up, the primary endpoint was observed in 35 patients in the group with triple therapy versus 36 patients in the group with dual therapy (Kaplan-Meier estimates 14.1% and 18.0%, OR = 0.76, 95% CI: 0.48-1.21; P = 0.25). Two-year incidence of major bleeding was 1.4% (n = 4, triple therapy) versus 3.1% (n = 6, dual therapy) (P = 0.34).

CONCLUSIONS

In patients on chronic OAC undergoing DES implantation, clinical and echocardiographic criteria help to define postprocedural antithrombotic/anticoagulation therapy. Based on these criteria, both a double antiplatelet therapy (clopidogrel plus aspirin) and a triple therapy (OAC plus clopidogrel plus aspirin) are associated with favourable safety and efficacy.

Authors+Show Affiliations

Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Technische Universität München, Munich, Germany. n.sarafoff@googlemail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

18624903

Citation

Sarafoff, N, et al. "Aspirin and Clopidogrel With or Without Phenprocoumon After Drug Eluting Coronary Stent Placement in Patients On Chronic Oral Anticoagulation." Journal of Internal Medicine, vol. 264, no. 5, 2008, pp. 472-80.
Sarafoff N, Ndrepepa G, Mehilli J, et al. Aspirin and clopidogrel with or without phenprocoumon after drug eluting coronary stent placement in patients on chronic oral anticoagulation. J Intern Med. 2008;264(5):472-80.
Sarafoff, N., Ndrepepa, G., Mehilli, J., Dörrler, K., Schulz, S., Iijima, R., ... Kastrati, A. (2008). Aspirin and clopidogrel with or without phenprocoumon after drug eluting coronary stent placement in patients on chronic oral anticoagulation. Journal of Internal Medicine, 264(5), pp. 472-80. doi:10.1111/j.1365-2796.2008.01989.x.
Sarafoff N, et al. Aspirin and Clopidogrel With or Without Phenprocoumon After Drug Eluting Coronary Stent Placement in Patients On Chronic Oral Anticoagulation. J Intern Med. 2008;264(5):472-80. PubMed PMID: 18624903.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aspirin and clopidogrel with or without phenprocoumon after drug eluting coronary stent placement in patients on chronic oral anticoagulation. AU - Sarafoff,N, AU - Ndrepepa,G, AU - Mehilli,J, AU - Dörrler,K, AU - Schulz,S, AU - Iijima,R, AU - Byrne,R, AU - Schömig,A, AU - Kastrati,A, Y1 - 2008/06/25/ PY - 2008/7/16/pubmed PY - 2008/12/17/medline PY - 2008/7/16/entrez SP - 472 EP - 80 JF - Journal of internal medicine JO - J. Intern. Med. VL - 264 IS - 5 N2 - OBJECTIVES: Optimal antithrombotic/anticoagulation therapy in patients on chronic oral anticoagulation (OAC) undergoing drug-eluting stent (DES) implantation is unknown. We investigated the efficacy and safety of two regimens of antithrombotic/anticoagulation therapy in patients who present for DES implantation whilst on OAC. METHODS: We included a series of 515 patients on OAC who underwent DES implantation between 2002 and 2007. Based on predefined clinical and echocardiographic criteria, 306 patients continued OAC (triple therapy) and 209 patients discontinued OAC (dual therapy) for the time they received antiplatelet therapy with clopidogrel and aspirin [stent-related antithrombotic treatment (SRAT)]. The primary end point was a composite of death, myocardial infarction, stent thrombosis or stroke. RESULTS: During SRAT the primary endpoint was observed in 13 patients in the group with triple therapy versus 15 patients in the group with dual therapy [Kaplan-Meier estimates 4.2% and 7.2%, odds ratio (OR) = 0.61, 95% confidence interval (CI) 0.29-1.28; P = 0.19]. At 2 years of follow-up, the primary endpoint was observed in 35 patients in the group with triple therapy versus 36 patients in the group with dual therapy (Kaplan-Meier estimates 14.1% and 18.0%, OR = 0.76, 95% CI: 0.48-1.21; P = 0.25). Two-year incidence of major bleeding was 1.4% (n = 4, triple therapy) versus 3.1% (n = 6, dual therapy) (P = 0.34). CONCLUSIONS: In patients on chronic OAC undergoing DES implantation, clinical and echocardiographic criteria help to define postprocedural antithrombotic/anticoagulation therapy. Based on these criteria, both a double antiplatelet therapy (clopidogrel plus aspirin) and a triple therapy (OAC plus clopidogrel plus aspirin) are associated with favourable safety and efficacy. SN - 1365-2796 UR - https://www.unboundmedicine.com/medline/citation/18624903/Aspirin_and_clopidogrel_with_or_without_phenprocoumon_after_drug_eluting_coronary_stent_placement_in_patients_on_chronic_oral_anticoagulation_ L2 - https://doi.org/10.1111/j.1365-2796.2008.01989.x DB - PRIME DP - Unbound Medicine ER -