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Short-term triple therapy with aspirin, warfarin, and a thienopyridine among patients undergoing percutaneous
Avital Porter1, Yuval Konstantino, Zaza Iakobishvili
1Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel.
Insights
Short-term triple therapy with warfarin, aspirin, and a thienopyridine after percutaneous coronary intervention (PCI) showed acceptable bleeding risk. This approach may be suitable for patients requiring warfarin.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Triple therapy (warfarin, aspirin, thienopyridine) is generally discouraged due to bleeding risks.
- Percutaneous coronary intervention (PCI) often requires antithrombotic therapy.
Purpose of the Study:
- To evaluate bleeding complications in patients receiving triple therapy post-PCI.
- To determine the safety of short-term triple therapy in specific patient populations.
Main Methods:
- Retrospective assessment of 180 patients undergoing PCI and receiving triple therapy for 30 days.
- Monitoring bleeding events during triple therapy and subsequent dual therapy (warfarin and aspirin).
Main Results:
- 20 bleeding complications occurred during triple therapy (2 major, 18 minor).
- 19 bleeding complications occurred during subsequent dual therapy (1 major, 18 minor).
- Bleeding rates were not prohibitively high.
Conclusions:
- Short-term triple therapy after PCI is associated with manageable bleeding risks.
- This regimen can be considered for patients with clear indications for warfarin.
Objectives:
To assess bleeding complications among patients undergoing percutaneous coronary intervention (PCI) and receiving triple therapy of warfarin, aspirin, and a thienopyridine.
Background:
Triple therapy of warfarin, aspirin, and a thienopyridine is strongly discouraged, given the potential risk of bleeding complications.
Methods And Results:
Post-PCI patients receiving triple therapy thereafter underwent assessment for bleeding complications. Continuous variables are presented as median (25th-75th percentiles). The study group included 180 patients (80% males; age 65 (52, 75.5)). PCI was on an urgent/emergent basis in 86.6%. The main indications for warfarin use were left ventricular mural thrombus and atrial fibrillation (46.9 and 36.9% respectively). Glycoprotein IIb/IIIa receptor antagonists were used in 47.7%. Post-PCI triple therapy duration was 30 days (30, 30). During the post-triple therapy, 104 patients (57.8%) continued treatment with warfarin and aspirin for 376 days (150, 775). During the triple therapy period, 20 patients developed bleeding complications, (mean INR 2.1 +/- 0.7 at 7 (6, 8.5) days post-PCI): 2 major groin hematoma (initial phase of warfarin treatment during overlap with heparin) and 18 minor. During post-triple therapy, primarily under warfarin and aspirin, 19 patients developed bleeding complications: 1 major and 18 minor.
Conclusion:
Short-term triple therapy after PCI was not associated with prohibitively high bleeding complication rates, and thus should be favorably considered in patients with a clear indication for warfarin use.
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