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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