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Coronary stenting in warfarin treated patients

Doron Zahger1, Reuben Ilia

  • 1Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel. dzahger@bgu.ac.il

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|June 17, 2009
PubMed

Insights

For patients needing both coronary stents and anticoagulation, avoid drug-eluting stents when possible. A short course of triple therapy followed by aspirin and warfarin is recommended to manage dual antiplatelet therapy and anticoagulation needs.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) is standard after coronary stent implantation.
  • A subset of patients requires chronic anticoagulation, often for atrial fibrillation.
  • No prospective trials guide therapy selection for this complex patient group.

Purpose of the Study:

  • To review existing data on managing patients requiring both DAPT and anticoagulation.
  • To provide practice recommendations for this clinical scenario.

Main Methods:

  • Review of available data and literature.
  • Synthesis of evidence to formulate clinical recommendations.

Main Results:

  • Drug-eluting stents should be used cautiously in patients needing both DAPT and anticoagulation, particularly if not at high bleeding risk.
  • A recommended regimen involves one month of triple therapy (aspirin, clopidogrel, warfarin).

Conclusions:

  • Following this initial period, long-term therapy with aspirin and warfarin is suggested.
  • This approach balances the need for antithrombotic protection after stenting with anticoagulation requirements.

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