European Heart Journal Advance Access originally published online on January 31, 2007
European Heart Journal 2007 28(6):726-732; doi:10.1093/eurheartj/ehl488
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Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting
1 Department of Cardiology, Satakunta Central Hospital, Sairaalantie 3, 28100 Pori, Finland
2 Department of Internal Medicine, Turku University Hospital, Turku, Finland
3 Heart Center, University Hospital of Tampere, Tampere, Finland
4 Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
5 Department of Cardiology, Vaasa Central Hospital, Vaasa, Finland
6 Department of Internal Medicine, Division of Cardiology, Oulu University Hospital, Oulu, Finland
7 Department of Biostatistics, University of Turku, Turku, Finland
Received 20 September 2006; revised 13 December 2006; accepted 4 January 2007; online publish-ahead-of-print 31 January 2007.
* Corresponding author. Tel: +358 2 6276656; fax: +358 2 6277757. E-mail address: pasi.karjalainen{at}satshp.fi
See page 657 for the editorial comment on this article (doi:10.1093/eurheartj/ehl576)
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.
Key Words: Anticoagulation • Warfarin • Stenting • Bleeding complications
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