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Efficacy and safety of therapeutic strategies after coronary stenting in chronically anticoagulated patients according to thromboembolic risk stratification. THE MUSICA STUDY.
  1. Antonia Sambola (asambola{at}
  1. Hospital Vall d'Hebron, Spain
    1. Ignacio Ferreira-Gonzalez (iferreira{at}
    1. Hospital Vall d'Hebron, Spain
      1. Joan Angel (jangel{at}
      1. Hospital Vall d'Hebron, Spain
        1. Fernando Alfonso (falf{at}
        1. Hospital Vall d'Hebron, Spain
          1. Jaume Maristany (jmaristany{at}
          1. Hospital Universitari Bellvitge, Spain
            1. Oriol Rodriguez (oriolrodriguez{at}
            1. Hospital Universitari Can Ruti, Spain
              1. Héctor Bueno
              1. Hospital Gregorio Marañón, Spain
                1. Jose Ramon Lopez-Minguez (jrlminguez{at}
                1. Hospital Universitario Infanta Cristina, Spain
                  1. Javier Zueco (heizgj{at}
                  1. Hospital Universitario Marques de Valdecilla, Spain
                    1. Francisco Fernandez-Aviles (fernandezaviles{at}
                    1. Hospital Universitario Gregorio Marañón, Spain
                      1. Alberto San Roman (sanroman{at}
                      1. ICICOR.Hospital Universitario Valladolid, Spain
                        1. Bernard Prendergast (bernard.prendergast{at}
                        1. Wythenshawe Hospital, United Kingdom
                          1. Vicente Mainar (mainar_vic{at}
                          1. Hospital Universitario Alicante, Spain
                            1. David Garcia-Dorado (dgdorado{at}
                            1. Hospital Universitari Vall d'Hebron, Spain
                              1. Pilar Tornos (ptornos{at}
                              1. Hospital Vall d'Hebron, Spain


                                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.

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