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[Coronary artery stenting without antivitamin K. Results after a month]
G Zemour1, M C Morice, E Benveniste
1Service de cardiologie, centre hospitalier Victor-Durouy, Argenteuil.
Insights
This study shows that combining ticlopidine and aspirin with heparin effectively reduces subacute occlusions after coronary stenting. This antithrombotic regimen is safe and may expand stenting indications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Thrombosis Research
Background:
- Coronary stenting is a common procedure to open blocked arteries.
- Subacute occlusions remain a significant complication post-stenting.
- Novel antithrombotic strategies are needed to improve outcomes.
Purpose of the Study:
- To evaluate a new antithrombotic regimen for reducing subacute occlusions after coronary stenting.
- To assess the safety and efficacy of combining ticlopidine, aspirin, and low molecular weight heparin.
- To determine if this protocol can broaden the use of coronary stenting.
Main Methods:
- A multicenter trial involving 1,294 patients undergoing coronary stenting.
- Treatment with ticlopidine (0.25 g/day) and aspirin (0.10 g/day) for one month post-procedure.
- Concomitant anticoagulation with low molecular weight heparin for variable durations.
- Implantation of 1,487 stents across various coronary vessels and grafts.
Main Results:
- A low incidence of subocclusion was observed at 1.7% (95% CI, 0.5%–2.9%).
- Major complications included 0.7% mortality and 1% myocardial infarction within the first month.
- Local hematomas or false aneurysms occurred in 10.5% of patients.
Conclusions:
- The combined antithrombotic therapy (ticlopidine, aspirin, LMWH) is associated with a low rate of subocclusion after coronary stenting.
- This regimen appears safe and effective, potentially allowing for wider application of coronary stenting.
- Further research may explore long-term outcomes and optimal duration of therapy.
Abstract:
This paper reports experience with a new antithrombotic agent prescribed to reduce the incidence of subacute occlusions during the first month after coronary stenting. Therefore, a powerful association of platelet antiaggregant agents was tested. From December 1992 to October 1994, coronary stenting was successfully achieved in 1,294 patients (1,118 men, average age 60.5 +/- 10 years) who were then treated with the association of ticlopidine 0.25 g/day and aspirin 0.10 g/day for one month. This was covered with anticoagulation with a low molecular weight heparin for a variable period (one month, two weeks, then one week), according to the different phases of the study protocol. In all, 1487 stents were successfully implanted (1,330 Palmaz Schatz; 63 Cook; 80 Wictor; 13 AVE and 1 Strecker) in 1,326 vessels (520 left anterior descending, 208 left circumflex, 475 right coronary, 16 left main coronary arteries and 107 venous grafts) using balloon catheters of 2.5 mm to 5 mm diameter for average 3.45 +/- 0.4 mm). Major complications in the first month included 9 deaths (0.7%), 22 occlusions (1.7%): 14 myocardial infarcts (1%) and 11 aorto-coronary bypass procedures (0.85%). There were 136 local haematomas or false aneurysms (10.5%), 42 of which (3.25%) required blood transfusion or surgical repair. This multicenter trial of a protocol associating platelet antiaggregant agents and low molecular weight heparin for one month showed a low incidence of subocclusion after coronary stenting (1.7 +/= 2.5%) and should enable interventional cardiologists to widen the indications for coronary stenting.