Abstract 17343: Triple Therapy (anticoagulation Plus Dual Antiplatelet Therapy) or Anticoagulation Plus Clopidogrel in Patients With a Mechanical Prosthesis Undergoing a Coronary Stent?
Background: Triple therapy (TT: anticoagulation, OAC plus dual antiplatelet therapy, DAPT) has been recommended for patients with mechanical prosthetic valves in whom a coronary stent (CS) is implanted. However, this treatment carries a high risk of bleeding, and the combination of OAC and clopidogrel could be an alternative in these patients.
Objectives: to assess the benefits and risks of OAC and clopidogrel compared with TT in patient with mechanical prosthetic valves.
Methods: we conducted a prospective study from 2008 to 2011 including patients with mechanical prostheses submitted to CS, comparing the incidence of thromboembolic and bleeding events in patients on TT vs OAC plus clopidogrel at 1- year follow-up.
Results: A total of 72 patients were included (11% female, 67 ± 12.5 years). Forty-two patients (38.3%) received TT and 30 (41.7%) OAC plus Clopidogrel (p=0.26). Baseline characteristics and comorbidities were similar in both: hypertension (71.4% vs 75%, p=0.48), diabetes mellitus (40.5% vs 28.6%, p=0.22), renal failure (10.3% vs 18.5%; p= 0.27) and previous stroke (40% vs 60%, p=0.35). The overall incidence of adverse events was similar in both treatment groups (31% vs 36.7%, p=0.39). There were no differences in the incidence of thromboembolic events (2.4% vs 0%, p=0.58), bleedings (21.4% vs 20%, p=0.56), total mortality (11.9% vs 6.7%, p=0.37) and cardiovascular mortality (9.5% vs 6.7%, p=0.55). However, the incidence of ischemic events because of target vessel failure were significantly higher in patients treated with OAC plus clopidogrel, compared with those who received TT (2.4% vs 20%;p=0.018). A multivariate analysis adjusted for age, diabetes, renal failure and number of diseased vessels showed as an independent predictor of new ischemic events by target vessel failure, the treatment with OAC plus clopidogrel (OR 9.97, 95% CI: 1.05-94.7, p=0.04).
Conclusions: Patients with mechanical prostheses submitted to CS and treated with OAC plus clopidogrel alone, without aspirin, have a higher incidence of ischemic events due to target vessel failure.
- © 2013 by American Heart Association, Inc.