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Correspondence to Michel E. Bertrand, Dept de Cardiologie B, Hôpital Cardiologique, 59037 Lille, France. E-mail bertrandme{at}aol.com
Background—Dual therapy with
ticlopidine and aspirin has been shown to be as effective as or more
effective than conventional anticoagulation in patients with an optimal
result after implantation of intracoronary metallic stents.
However, the safety and efficacy of antiplatelet therapy alone in
an unselected population has not been evaluated.
Methods—Patients were randomized to conventional anticoagulation
or to treatment with antiplatelet therapy alone. Indications for
stenting were classified as elective (decided before the procedure) or
unplanned (to salvage failed angioplasty or to optimize the results of
balloon angioplasty). After stenting, patients received aspirin and
either ticlopidine or conventional anticoagulation (heparin or oral
anticoagulant). The primary end point was the occurrence of bleeding or
peripheral vascular complications; secondary end points
were cardiac events (death, infarction, or stent occlusion) and
duration of hospitalization.
Results—In 13 centers, 236 patients were randomized to
anticoagulation and 249 to antiplatelet therapy. Stenting was
elective in 58% of patients and unplanned in 42%. Stent implantation
was successfully achieved in 99% of patients. A primary end point
occurred in 33 patients (13.5%) in the antiplatelet group and 48
patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI
0.36 to 0.98], P=0.03). Major cardiac-related events in
electively stented patients were less common (odds ratio=0.23 [95% CI
0.05 to 0.91], P=0.01) in the antiplatelet group (3
of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%).
Hospital stay was significantly shorter in the antiplatelet group
(4.3±3.6 versus 6.4±3.7 days, P=0.0001).
Conclusions—Antiplatelet therapy after coronary
stenting significantly reduced rates of bleeding and subacute stent
occlusion compared with conventional anticoagulation.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Randomized Multicenter Comparison of Conventional Anticoagulation Versus Antiplatelet Therapy in Unplanned and Elective Coronary Stenting
The Full Anticoagulation Versus Aspirin and Ticlopidine (FANTASTIC) Study
Key Words: stents • antiplatelet agents • anticoagulants
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G. Wilms, F. v. Calenbergh, L. Stockx, P. Demaerel, J. van Loon, and J. Goffin Endovascular Treatment of a Ruptured Paraclinoid Aneurysm of the Carotid Syphon Achieved Using Endovascular Stent and Endosaccular Coil Placement AJNR Am. J. Neuroradiol., April 1, 2000; 21(4): 753 - 756. [Abstract] [Full Text]
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G. L. Kaluza, J. Joseph, J. R. Lee, M. E. Raizner, and A. E. Raizner Catastrophic outcomes of noncardiac surgery soon after coronary stenting J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1288 - 1294. [Abstract] [Full Text] [PDF]
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P. B. Berger, M. R. Bell, C. S. Rihal, H. Ting, G. Barsness, K. Garratt, V. Bellot, V. Mathew, S. Melby, L. Hammes, et al. Clopidogrel versus ticlopidine after intracoronary stent placement J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1891 - 1894. [Abstract] [Full Text] [PDF]
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M. J. Quinn and D. J. Fitzgerald Ticlopidine and Clopidogrel Circulation, October 12, 1999; 100(15): 1667 - 1672. [Abstract] [Full Text] [PDF]
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A. Brodison, R. S More, and A. Chauhan Stents in medicine: The role of coronary angioplasty and stenting in acute myocardial infarction Postgrad. Med. J., October 1, 1999; 75(888): 591 - 598. [Abstract] [Full Text]
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