Article Text

Download PDFPDF
Interventional cardiology
Therapeutic strategies after coronary stenting in chronically anticoagulated patients: the MUSICA study
  1. A Sambola1,
  2. I Ferreira-González1,11,
  3. J Angel1,
  4. F Alfonso2,
  5. J Maristany3,
  6. O Rodríguez4,
  7. H Bueno5,
  8. J R López-Minguez6,
  9. J Zueco7,
  10. F Fernández-Avilés5,
  11. A San Román8,
  12. B Prendergast9,
  13. V Mainar10,
  14. D García-Dorado1,
  15. P Tornos1
  1. 1
    Area del Cor Hospital, Universitari Vall d’Hebron, Barcelona, Spain
  2. 2
    Hospital Clínico de Madrid, Madrid, Spain
  3. 3
    Hospital de Bellvitge, Barcelona, Spain
  4. 4
    Hospital Germans Trias i Pujol, Barcelona, Spain
  5. 5
    Hospital Gregorio Marañón, Madrid, Spain
  6. 6
    Hospital Infanta Cristina, Badajoz, Spain
  7. 7
    Hospital de Valdecilla, Santander, Spain
  8. 8
    ICICOR Valladolid, Spain
  9. 9
    The John Radcliffe Hospital, Oxford, UK
  10. 10
    Hospital Universitario de Alicante, Alicant, Spain
  11. 11
    CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  1. Correspondence to Dr A Sambola, Servei de Cardiologia, Hospital Universitari Vall d’ Hebron, P Vall d’Hebron 119–129, 08035 Barcelona, Spain; asambola{at}


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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding The Spanish Network for Research in Cardiovascular diseases REIPI RD 06/0014/0025.

  • Competing interests None.

  • Ethics approval Approval from the ethics committee of each participant hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.