Efficacy and safety of therapeutic strategies after coronary stenting in chronically anticoagulated patients according to thromboembolic risk stratification. THE MUSICA STUDY

Antonia Sambola ^1*, Ignacio Ferreira-Gonzalez ¹, Joan Angel ¹, Fernando Alfonso ¹, Jaume Maristany ², Oriol Rodriguez ³, Jose Ramon Lopez-Minguez ⁴, Javier Zueco ⁵, Francisco Fernandez-Aviles ⁶, Alberto San Roman ⁷, Bernard Prendergast ⁸, David Garcia-Dorado ⁹, Vicente Mainar ¹⁰ and Pilar Tornos ¹

¹ Hospital Vall d'Hebron, Spain
² Hospital Universitari Bellvitge, Spain
³ Hospital Universitari Can Ruti, Spain
⁴ Hospital Universitario Infanta Cristina, Spain
⁵ Hospital Universitario Marques de Valdecilla, Spain
⁶ Hospital Universitario Gregorio Marañon, Spain
⁷ ICICOR.Hospital Universitario Valladolid, Spain
⁸ Wythenshawe Hospital, United Kingdom
⁹ Hospital Universitari Vall d'Hebron, Spain
¹⁰ Hospital Universitario Alicante, Spain

^* To whom correspondence should be addressed. E-mail: asambola{at}yahoo.com.

Accepted 5 May 2009

Abstract

Objectives: 1) To identify the therapeutic regimens used at discharge in patients on oral anticoagulant therapy (OAT) who undergo stenting (PCI-S) and 2) to assess the safety and the efficacy associated with different therapeutic regimens according to the thromboembolic risk.

Design: A prospective multicenter registry.

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

Methods: We included patients who underwent PCI-S between November 2003 and June 2006 from nine catheterization laboratories of tertiary care teaching hospitals in Spain and one from the United Kingdom.

Results: 405 patients (328 male/71 female; 71±9 y) on OAT were included. Three therapeutic regimens were identified at discharge: triple therapy (TT), any anticoagulant (AC) plus double antiplatelet therapy (DAT), 278 patients (68.6%); AC and a single antiplatelet (AC+AT), 46 (11.4%) and (DAT), 81 (20%). At 6 months, patients on TT showed the greatest rate of bleeding events. No patients on DAT at low thromboembolic risk presented a bleeding event (14.8% on TT, 11.8% on AC+AT and 0% on DAT, p=0.033) or cardiovascular event (6.7% on TT, 0% on AC+AT and 0% on 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 on 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 than TT in patients at low thromboembolic risk. TT should probably be restricted to patients at moderate-high thromboembolic risk.