European Heart Journal Advance Access originally published online on June 11, 2007
European Heart Journal 2007 28(14):1717-1722; doi:10.1093/eurheartj/ehm186
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Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events: is it safe and effective to use just one antiplatelet agent?
1 Centre for Cardiovascular Therapeutics, Western Hospital, Melbourne, Australia
2 Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
3 Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
4 Canadian Heart Research Centre and Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
5 Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
6 Department of Cardiology, Krankenhaus Düren, Düren, NRW, Germany
7 Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
8 Department of Cardiology, Concord Hospital, Sydney, Australia
Received 26 June 2006; revised 16 April 2007; accepted 25 April 2007; online publish-ahead-of-print 11 June 2007.
* Corresponding author: Department of Cardiology, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Baker 4, Boston, MA 02215, USA. Tel: +1 617 632 7718; fax: +1 617 632 7460. E-mail address: mcnguyen{at}bidmc.harvard.edu
Aims: To identify factors associated with the use of single or dual antiplatelet therapy in patients prescribed warfarin following coronary stenting and to investigate whether single (aspirin or thienopyridine) vs. dual antiplatelet therapy plus warfarin leads to an excess of adverse outcomes.
Methods and results: We analysed data from 800 patients with an acute coronary syndrome who underwent coronary stenting (130 patients received a drug-eluting stent) and were discharged on warfarin and either dual (n = 580) or single (n = 220) antiplatelet therapy. The use of single antiplatelet therapy was more common in Europe than in the USA (34 vs. 17%, P < 0.001). There was no difference in major bleeding in hospital or in 6-month mortality or myocardial infarction. In the single antiplatelet group, the use of either aspirin or thienopyridine (clopidogrel or ticlopidine) in combination with warfarin resulted in similar outcomes.
Conclusion: Use of single vs. dual antiplatelet therapy and warfarin following stenting is common. In this observational study, there was no difference in mortality or myocardial infarction at 6 months; however, larger trials are needed to assert any firm recommendations.
Key Words: Warfarin • Antiplatelet therapy • Acute coronary syndromes
Preliminary results of this study were presented as an Abstract at the 2006 Annual Scientific Session of the American College of Cardiology, Atlanta, GA, USA and were published in J Am Coll Cardiol 2006;47:252A.
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