Abstract 3072: Therapeutic Strategies After Stent Placement in Chronic Anticoagulated Patients: Effectiveness and Safety in Daily Clinical Practice. MUSICA STUDY
Background. Dual antiplatelet therapy with aspirin (AAS) and clopidogrel (CL) after stent coronary placement is mandatory. However, in previously anticoagulated patients there are not recommendations in guidelines.
Methods and Results. A prospective multicentric registry was performed in chronicaly anticoagulated patients submitted to stenting between November 2003 to January 2006 in order to assess which regimes were used in daily practice and the rate of complications (bleeding, stent thrombosis and thromboembolism) during hospitalization and at 6 months follow-up. Three-and two consecutive pts. were identified (245 male/57 female 70±9 y). Reasons for anticoagulation were: prosthetic valve in 46 pts (15%), atrial fibrillation in 202 pts (67%), and other causes in 54 pts (18%). After stenting 161 pts (53%) were discharged on acenocumarol (AC)+AAS+CL, 29 pts (9.6%) on low-molecular weight heparin (LMWH)+AAS+CL, 30 pts (9.9%) on AC+CL, 76 pts (25.2%) on AAS+CL, and 6 pts (2%) with other therapeutic regimens: 2 pts on AC+AAS and other pt with LMWH+AAS. The choice of therapeutic regimens was influenced by the indication for anticoagulation (29.7% of patients with atrial fibrillation received only AAS+CL). Bleeding events occured in 45 pts (16%). Thirteen pts (28.9%) had a major bleeding, one of them presented a cranial hemorrhage and died, the remaining 6 pts required transfusion (2.7%); OR 2.65 [ 95% CI: 1.21–5.8]; p=0.008. All most major bleeding occurred in patients treated with 3 drugs: 8 pts on AC+CL+AAS and 4 pts on LMWH+CL+AAS. Two patients on AAS+CL suffered a stent thrombosis 1 month after self-withdrawal of CL and other two patients with atrial fibrillation on AAS+clopidogrel had a thromboembolic episode six months after discharge.
Conclusions: Different therapeutic options are used to treat chronic anticoagulated patients after stent placement. The risk of bleeding is increased in patients treated with either AC or LMWH and AAS+CL. Our results suggest that triple therapy should be restricted to pts. with a strong reason for anticoagulation (prosthetic valve, high risk atrial fibrillation).