Original articles

Therapeutic strategies after coronary stenting in chronically anticoagulated patients: the MUSICA study

A Sambola¹, I Ferreira-González^1,11, J Angel¹, F Alfonso², J Maristany³, O Rodríguez⁴, H Bueno⁵, J R López-Minguez⁶, J Zueco⁷, F Fernández-Avilés⁵, A San Román⁸, B Prendergast⁹, V Mainar¹⁰, D García-Dorado¹, P Tornos¹

¹ Area del Cor Hospital, Universitari Vall d’Hebron, Barcelona, Spain
² Hospital Clínico de Madrid, Madrid, Spain
³ Hospital de Bellvitge, Barcelona, Spain
⁴ Hospital Germans Trias i Pujol, Barcelona, Spain
⁵ Hospital Gregorio Marañón, Madrid, Spain
⁶ Hospital Infanta Cristina, Badajoz, Spain
⁷ Hospital de Valdecilla, Santander, Spain
⁸ ICICOR Valladolid, Spain
⁹ The John Radcliffe Hospital, Oxford, UK
¹⁰ Hospital Universitario de Alicante, Alicant, Spain
¹¹ CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

^{Correspondence to} Dr A Sambola, Servei de Cardiologia, Hospital Universitari Vall d’ Hebron, P Vall d’Hebron 119–129, 08035 Barcelona, Spain; asambola{at}vhebron.net

Objectives: To identify the therapeutic regimens used at discharge in patients receiving oral anticoagulant therapy (OAT) who undergo stenting percutaneous coronary intervention and stent implantation (PCI-S), and to assess the safety and efficacy associated with different therapeutic regimens according to thromboembolic risk.

Design: A prospective multicentre registry.

Setting: In hospital, after discharge and follow-up by telephone call.

Patients and methods: 405 patients (328 male/77 female; mean (SD) age 71 (9) years) receiving OAT who underwent PCI-S between November 2003 and June 2006 from nine catheterisation laboratories of tertiary care teaching hospitals in Spain and one in the United Kingdom were included.

Results: Three therapeutic regimens were identified at discharge: triple therapy (TT)—that is, any anticoagulant (AC) plus double antiplatelet therapy (DAT; 278 patients (68.6%); AC and a single antiplatelet (AC+AT; 46 (11.4%)) and DAT only (81 (20%)). At 6 months, patients receiving TT showed the greatest rate of bleeding events. No patients receiving DAT at low thromboembolic risk presented a bleeding event (14.8% receiving TT, 11.8% receiving AC+AT and 0% receiving DAT, p = 0.033) or cardiovascular event (6.7% receiving TT, 0% receiving AC+AT and 0% receiving DAT, p = 0.126). The combination of AC+AT showed the worst rate of adverse events in the whole cohort, especially in patients at moderate–high thromboembolic risk.

Conclusions: In patients receiving OAT, TT was the most commonly used regimen after PCI-S. DAT was associated with the lowest rate of bleeding events and a similar efficacy to TT in patients at low thromboembolic risk. TT should probably be restricted to patients at moderate–high thromboembolic risk.

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