Journal
CARDIOLOGY
Volume 104, Issue 2, Pages 101-106Publisher
KARGER
DOI: 10.1159/000086918
Keywords
coronary angioplasty; coronary stent; oral anticoagulants; ticlopidine; aspirin; antiplatelets
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The combination of oral anticoagulation (OAC) and aspirin was the antithrombotic treatment initially adopted after coronary stenting (PCI-S). Although dual antiplatelet therapy with aspirin and a thienopyricline subsequently proved safer and more effective, OAC and aspirin combination is still used in patients with an indication for long-term OAC undergoing PCI-S. The absolute (AR) and relative MR) risk of cardiac events and hemorrhagic/ vascular complications of OAC and aspirin versus antiplatelet therapy were evaluated in a meta-analysis of four historical clinical trials. In 2,436 patients, the RR of a 30-day primary composite endpoint of death, myocardial infarction and the need for revascularization was significantly reduced by antiplatelet therapy (RR 0.41; 95% CI 0.25-0.69), whereas the RR of stent thrombosis (RR 0.26; 95% CI 0.06-1.14) and major bleeding (RR 0.36; 95% CI 0.14-1.02) was not statistically different. The 30-day AR of death, myocardial infarction, need for revascularization, major bleedings and vascular complications with OAC and aspirin were 0.65,3.8,4.2,6.4 and 6.6%, respectively. In conclusion, due to the lowAR of adverse events, the combination of OAC and aspirin appears an acceptable treatment after PCI-S in patients in whom long-term OAC is deemed mandatory. Copyright (c) 2005 S. Karger AG, Basel.
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