Comparison of aspirin alone versus aspirin plus ticlopidine after coronary artery stenting

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Pharmacology

Background:

• Coronary artery stenting is a common procedure to treat coronary artery disease.
• Dual antiplatelet therapy is standard after stenting, but optimal regimen is debated.
• Aspirin alone is sometimes used, but its efficacy in preventing stent-related complications is questioned.

Purpose of the Study:

• To compare the efficacy of aspirin alone versus aspirin and ticlopidine combination therapy in preventing adverse events following native coronary artery stenting.

Main Methods:

• Prospective, nonrandomized study design.
• Patients undergoing native coronary artery stenting were assigned to two groups: aspirin alone (n=46) or aspirin plus ticlopidine (n=338).
• Outcomes assessed included stent thrombosis, Q-wave myocardial infarction, and cardiac-related death.

Main Results:

• Significantly lower rates of stent thrombosis in the aspirin and ticlopidine group (0.9%) compared to the aspirin-only group (6.5%) (p=0.02).
• Significantly fewer Q-wave myocardial infarctions and cardiac-related deaths in the combination therapy group (0%) versus the aspirin-only group (6.5%, p=0.002 and 0.3%, p=0.02, respectively).

Conclusions:

• Combination therapy with aspirin and ticlopidine is superior to aspirin alone in reducing stent thrombosis and major adverse cardiac events after native coronary artery stenting.
• This finding supports the use of dual antiplatelet therapy, specifically including ticlopidine, in high-risk patients undergoing coronary stenting.