Reduced Anticoagulation with Antiplatelet Therapy Alone is Safe and Effective after "Bail-Out" Stenting for Failed...

The aim of this retrospective study was to compare the safety and efficacy of antiplatelet therapy alone with conventional anticoagulation with warfarin after Òbail-outÓ coronary stenting for failed balloon angioplasty at a tertiary referral centre. Eighty-two consecutive patients undergoing Òbail-outÓ stenting over a 22-month-period were studied. Forty patients received antiplatelet therapy alone with aspirin and ticlopidine and 42 patients received anticoagulation with warfarin for 30 days. The main outcome measures examined were death, myocardial infarction, coronary artery bypass surgery, repeat angioplasty, and significant vascular complications. The angiographic procedural success rate was 100% in both groups. At six weeks there were no deaths and no patient required emergency coronary artery bypass surgery in either group. There were three (7.1%, p = NS) stent thromboses and two (4.8%, p = NS) Q-wave myocardial infarctions in the warfarin group as compared to none in the antiplatelet group. There was a significantly higher incidence of vascular complications in the warfarin group (21.4% vs. 0%, p = 0.004). The length of hospital stay was significantly shorter in the antiplatelet group [3.4 (2.0) vs. 7.8 (2.6) days, p < 0.001]. This study suggests that reduced anticoagulation with antiplatelet therapy alone after Òbail-outÓ stenting is an effective and safe strategy which reduces vascular complications and hospital stay without increasing the rate of stent thrombosis.