Coronary artery diseaseLong-Term Outcomes in Patients Undergoing Coronary Stenting on Dual Oral Antiplatelet Treatment Requiring Oral Anticoagulant Therapy
Section snippets
Methods
All consecutive patients undergoing coronary stent implantation treated with aspirin (100 mg/day) and clopidogrel (75 mg/day) and who also required oral anticoagulant therapy were prospectively evaluated at 3 institutions. Between October 2005 and August 2006, a total of 1,678 consecutive patients underwent stent implantation. Of these, 118 (7%) required concomitant oral anticoagulant therapy. Patients with mechanical valve prosthesis (n = 16) were excluded. In patients meeting study
Results
A total of 102 study patients were available for the present analysis; 64 patients were discharged on triple therapy, and 34 of these were already on oral anticoagulation for >1 month at the time of hospitalization. Oral anticoagulation was suspended in patients already on oral anticoagulation, except for those presenting with ST-elevation myocardial infarction (n = 11), and PCI was performed when an INR value <1.5 was reached. In the remaining 38 patients, the need for oral anticoagulant
Discussion
The optimal antithrombotic therapy in patients undergoing coronary stenting in whom dual antiplatelet therapy is required but who also have an indication for oral anticoagulation represents a common clinical problem that clinicians frequently face. The fine balance between safety and efficacy in this cohort needs careful consideration. In fact, discontinuation of antiplatelet therapy increases the risk of stent thrombosis, and even temporary withholding of anticoagulant increases the risk of
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2018, International Journal of CardiologyCitation Excerpt :To date, no dedicated studies have been carried out in VTE patients on OAC undergoing PCI. When included in experiences evaluating the use and outcome of antithrombotic therapies in patients with a general indication for OAC who were submitted to PCI, the proportion of VTE patients was small, ranging from approximately 2 to 17% (10% on average), as opposed to 22 to 85% (61% on average) for AF, and, most importantly, outcome data were not given separately (Table 1) [3–33]. Also, the absolute incidence of (recurrent) VTE during follow-up was as little as less than 1%, whereas that of stroke was in the range of 0 to 9% (1.5% on average) (Table 1) [3–33].
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