Abstract 18618: Is It Safe Placing a Drug Eluting Stent in Patients Requiring Long-term Anticoagulation?
Introduction: Drug-eluting stents (DES) reduce in stent restenosis as compared with bare-metal stents (BMS). Current guidelines recommend to avoid the use of DES in patients requiring long-term anticoagulation (OAC) undergoing PCI with stenting (PCI-S) due to an increased risk of bleeding associated to the use of triple therapy (TT: dual antiplatelet treatment (DAPT) and OAC).
Hypothesis: DES would be safe in a selected population.
Objective: To assess the safety of DES vs BMS placement in patients requiring long-term OAC for any cause undergoing PCI-S.
Methods: A prospective multicenter study was conducted from 2007 to 2012 to identify patients requiring long-term OAC undergoing PCI-S. All adverse outcomes were analyzed at 1-year follow-up.
Results: We identified 828 patients requiring OAC (77.3% male, 72.0±9.3 years) undergoing PCI-S. 334 (40.3%) patients received DES and 494 (59.7%) BMS. Patients who received DES were more frequently diabetic (41.4% vs 30.2%, p=0.001), had more frequently a previous PCI (37.2% vs 29.4%, p=0.02), a previous CABG (17.8% vs 11.8%, p=0.002) or a previous myocardial infarction (41.5% vs 32.6%, p=0.006). A HAS-BLED≥3 was less frequent in patients who received a DES (30.6% vs 42.3%, p=0.006). Patients who received a DES had an acute coronary syndrome as index event, more frequently that those who received a BMS (35.2% vs 21.4%, p=0.0001). After discharge, choice of treatment with TT was similar (51% vs 50%), but patients who received a DES were treated less frequently with OAC plus clopidogrel (4.9% vs 9.7%, p=0.002). Through follow-up, stent thrombosis rate was identical in DES and BMS groups (1.8% vs 1.8%) and MACE rate and all-cause mortality were also similar in both groups. In addition, patients with DES and BMS suffered a similar rate of bleeding events (18.3% vs 17%, p=0.35) or major bleeding (6.8% vs 4.8%, p=0.21). In a multivariable analysis, renal failure and combination of clopidogrel plus OAC were predictors of MACE while age, renal failure and clopidogrel plus OAC were predictors of all-cause mortality. The use of DES was not a predictor of those adverse events.
Conclusion: In patients with higher incidence of restenosis, selective use of DES seems to be safe in patients requiring long-term OAC.
- Antiplatelet drugs
- Atrial fibrillation
- Percutaneous coronary intervention (PCI)
- Drug eluting stents
Author Disclosures: A. Sambola: None. A. Santos: None. B. García Del Blanco: None. B. Miranda: None. M. Mutuberria: None. J. Limeres: None. J. Barrabés: None. F. Alfonso: None. H. Bueno: None. D. García-Dorado: None.
- © 2014 by American Heart Association, Inc.