Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting.
Pasi P. Karjalainen,Pekka Porela,Antti Ylitalo,Saila Vikman,Kai Nyman,Mari-Anne Vaittinen,Tuukka Airaksinen,Matti Niemelä,Tero Vahlberg,K.E. Juhani Airaksinen +9 more
TLDR
It is shown that the prognosis is unsatisfactory in warfarin-treated patients irrespective of the drug combination used, and aspirin plus Warfarin combination seems to be inadequate to prevent stent thrombosis.Abstract:
Aim The aim of this study was to evaluate the antithrombotic treatment adopted after coronary stenting in patients requiring long-term anticoagulation.
Methods and results We analysed retrospectively all consecutive patients on warfarin therapy ( n = 239, mean age 70 years, men 74%) who underwent percutaneous coronary intervention (PCI) in 2003–04 in six hospitals. An age- and sex-matched control group with similar disease presentation (unstable or stable symptoms) was selected from the study period. Primary endpoint was defined as the occurrence of death, myocardial infarction, target vessel revascularization, or stent thrombosis at 12 months. Warfarin treatment was an independent predictor of both primary endpoint (OR 1.7, 95% CI 1.0–3.0, P = 0.05) and major bleeding (OR 3.4, 95% CI 1.2–9.3, P = 0.02). Triple therapy with aspirin and clopidogrel was the most common (48%) option in stented patients in warfarin group, and there was a significant ( P = 0.004) difference between the drug combinations in stent thrombosis with the highest (15.2%) incidence in patients receiving warfarin plus aspirin combination.
Conclusion Our study shows that the prognosis is unsatisfactory in warfarin-treated patients irrespective of the drug combination used. Aspirin plus warfarin combination seems to be inadequate to prevent stent thrombosis.read more
Citations
More filters
Journal ArticleDOI
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society
Craig T. January,L. Samuel Wann,Joseph S. Alpert,Hugh Calkins,Joaquin E. Cigarroa,Joseph C. Cleveland,Jamie B. Conti,Patrick T. Ellinor,Michael D. Ezekowitz,Michael E. Field,Katherine T. Murray,Ralph L. Sacco,William G. Stevenson,Patrick J. Tchou,Cynthia M. Tracy,Clyde W. Yancy +15 more
TL;DR: This document summarizes current research, plans, and recommendations for future research, as well as providing a history of the field and some of the techniques used, currently in use, at the National Institutes of Health.
Journal ArticleDOI
Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Larry B. Goldstein,Cheryl Bushnell,Robert J. Adams,Lawrence J. Appel,Lynne T. Braun,Seemant Chaturvedi,Mark A. Creager,Antonio Culebras,Robert H. Eckel,Robert G. Hart,Judith A. Hinchey,Virginia J. Howard,Edward C. Jauch,Steven R. Levine,James F. Meschia,Wesley S. Moore,J.V. (Ian) Nixon,Thomas A. Pearson +17 more
TL;DR: Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombosis and thromboembolic stroke.
Journal ArticleDOI
Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology.
Frans Van de Werf,Jeroen J. Bax,Amadeo Betriu,Carina Blomström-Lundqvist,Filippo Crea,Volkmar Falk,Gerasimos Filippatos,Keith A.A. Fox,Kurt Huber,Adnan Kastrati,Annika Rosengren,P. Gabriel Steg,Marco Tubaro,Freek W.A. Verheugt,Franz Weidinger,Michael Weis,Alec Vahanian,John Camm,Raffaele De Caterina,Veronica Dean,Kenneth Dickstein,Christian Funck-Brentano,Irene Hellemans,Steen Dalby Kristensen,Keith McGregor,Udo Sechtem,Sigmund Silber,Michal Tendera,Petr Widimsky,José Luis Zamorano,Frank V. Aguirre,Nawwar Al-Attar,Eduardo Alegría,Felicita Andreotti,Werner Benzer,Ole A. Breithardt,Nicholas Danchin,Carlo Di Mario,Dariusz Dudek,Dietrich C. Gulba,Sigrun Halvorsen,Philipp A. Kaufmann,Ran Kornowski,Gregory Y.H. Lip,Frans H. Rutten +44 more
TL;DR: Guidelines and Expert Consensus Documents summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategies for a typical patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk/benefit ratio of particular diagnostic or therapeutic means.
Journal ArticleDOI
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary
Craig T. January,L. Samuel Wann,Joseph S. Alpert,Hugh Calkins,Joaquin E. Cigarroa,Joseph C. Cleveland,Jamie B. Conti,Patrick T. Ellinor,Michael D. Ezekowitz,Michael E. Field,Katherine T. Murray,Ralph L. Sacco,William G. Stevenson,Patrick J. Tchou,Cynthia M. Tracy,Clyde W. Yancy +15 more
TL;DR: The medical profession should play a central role in evaluating the evidence related to drugs, devices, and procedures for the detection, management, and prevention of disease.
Journal ArticleDOI
Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial
Willem Dewilde,Tom Oirbans,Freek W.A. Verheugt,Johannes C. Kelder,Bart J.G.L. de Smet,Jean-Paul R. Herrman,Tom Adriaenssens,Mathias Vrolix,A. A. C. M. Heestermans,Marije M. Vis,Jan G. P. Tijsen,Arnoud W. van 't Hof,Jurriën M. ten Berg +12 more
TL;DR: Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events.
References
More filters
Journal ArticleDOI
Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.
Salim Yusuf,Zhao F,Shamir R. Mehta,Susan Chrolavicius,Gianni Tognoni,K K Fox,Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators +6 more
TL;DR: The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation, however, the risk of major bleeding is increased among patients treated with clopIDogrel.
Journal ArticleDOI
Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation
Brian F. Gage,Amy D. Waterman,William D. Shannon,Michael Boechler,Michael W. Rich,Martha J. Radford +5 more
TL;DR: The 2 existing classification schemes and especially a new stroke risk index, CHADS, can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.
Journal ArticleDOI
Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery.
Jeffrey W. Moses,Martin B. Leon,Jeffrey J. Popma,Peter J. Fitzgerald,David R. Holmes,Charles O'Shaughnessy,Ronald P. Caputo,Dean J. Kereiakes,David O. Williams,Paul S. Teirstein,Judith Jaeger,Richard E. Kuntz +11 more
TL;DR: In this randomized clinical trial involving patients with complex coronary lesions, the use of a sirolimus-eluting stent had a consistent treatment effect, reducing the rates of restenosis and associated clinical events in all subgroups analyzed.
Journal ArticleDOI
Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial.
Steven R. Steinhubl,Peter B. Berger,J. Tift Mann,Edward T.A. Fry,Augustin DeLago,Charles Wilmer,Eric J. Topol +6 more
TL;DR: Following PCI, long-term clopidogrel therapy significantly reduced the risk of adverse ischemic events and subgroup analyses suggest that longer intervals between the loading dose and PCI may reduce events.
Journal ArticleDOI
Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.
Shamir R. Mehta,Salim Yusuf,Ron J.G. Peters,Michel E. Bertrand,Basil S. Lewis,Madhu K. Natarajan,Klas Malmberg,Hans-Jürgen Rupprecht,Feng Zhao,Susan Chrolavicius,Ingrid Copland,Keith A.A. Fox +11 more
TL;DR: In patients with acute coronary syndrome receiving aspirin, a strategy of clopidogrel pretreatment followed by long-term therapy is beneficial in reducing major cardiovascular events, compared with placebo.