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[Coronary endoprosthesis (stents) implanted without coumadin administration: one year's experience]
A Pérez de Prado1, E J García, M Abeytua
1Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid.
Insights
Coronary stenting without oral anticoagulation showed low rates of subacute occlusion and complications. This approach may be a safe alternative for patients undergoing stenting procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Subacute occlusion and bleeding are significant limitations in coronary stenting.
- The necessity of oral anticoagulation to prevent stent occlusion is debated.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary stenting without oral anticoagulation.
- To assess the rates of subacute occlusion and bleeding complications in patients treated with a specific antiplatelet regimen.
Main Methods:
- 121 patients underwent 125 coronary stent procedures with initial angiographic success.
- Patients received intravenous heparin and aspirin during the procedure, followed by oral aspirin and ticlopidine.
- A subset of patients also received enoxaparin for 10 days.
Main Results:
- 172 stents were implanted in 148 lesions, with high-pressure deployment.
- No subacute occlusions were observed during follow-up (30-441 days).
- Bleeding and vascular complication rates were low (0.8% and 1.6%, respectively).
Conclusions:
- Coronary stenting with high-pressure dilatation and without subsequent anticoagulation is associated with low subacute occlusion rates.
- This strategy appears safe, with minimal bleeding or vascular complications.
Background And Objectives:
Subacute occlusion and bleeding complications have been the major limitations of coronary stenting. Several authors have suggested the nonessential role of oral anticoagulation to prevent occlusions.
Methods:
We treated 121 patients (125 stent procedures with initial angiographic success) with the following regimen: heparin 10-20,000 IU i.v. and ASA 325 mg i.v. during the procedure, followed by ASA 125-325 mg/day/6 months and ticlopidine 250-500 mg/day/3 months. 40 patients were also treated with enoxaparine (14,000 IU/day, median) for 10 days.
Results:
172 stents (119 Palmaz-Schatz, 35 Wiktor and 18 of other types) were implanted in 148 lesions (in 45 cases with non-occlusive dissection or suboptimal results and the rest electively). Most of the stents were deployed at high pressure (median 14 atm.). The procedure was ended when the stent expansion was considered as optimal by angiography and/or intravascular ultrasound. No patient developed signs of subacute occlusion at follow-up (30-441 days). 2 patients developed non-Q wave myocardial infarction (occlusion of side branches). The rates of bleeding and vascular complications were 0.8% and 1.6%, respectively.
Conclusions:
Coronary stenting with high pressure dilatation and without subsequent anticoagulation seems to be associated with low rates of subacute occlusion and bleeding or vascular complications.