951-73 Combined Antiplatelet Therapy without Anticoagulation: An Effective Alternative to Prevent Subacute Thrombosis After Coronary Stenting?A 3 Month Follow-up

Abstract

Stent implantation is limited by the occurrence of subacute stent occlusion and local complications related to anticoagulant therapy. Subacute closure is usually delayed and may occur several weeks after stent implantation. Recent data suggest that antiplatelet therapy might be an effective alternative to classical anticoagulation. We are prospectively studying the use of a combined antiplatelet therapy without anticoagulation (heparin discontinued within 48 hours and no coumadin) in consecutive and successful stent procedures in our institution. All patients received aspirin 200 mg daily continued indefinitely, dextran infusion during the procedure and for 4 days and ticlopidine 500 mg daily begun within one hour following a successful procedure and continued for 3 months. The 3 month follow-up (range: 1–7 months) of the first 53 patients stented during the first 10 months is presented. Stent implantation was required mainly for failed PTCA (n = 50) including 41 cases for acute or threatened closure. These stent procedures represented 6.4% of total procedures during this period. PTCA indications were stable angina (n = 18), unstable angina (n = 18), recent myocardial infarction (n = 15) and acute myocardial infarction (n = 2). Sixty-seven stents were implanted (Wiktor, n = 50; Palmaz-Schatz, n = 7; Gianturco-Roubin, n = 10) in 53 arteries (saphenous vein grafts, n = 2; left anterior descending artery, n = 19; circumflex artery, n = 11; and right coronary artery, n = 21). Mean stent diameter was 3.43 ± 0.34 mm (range: 2.5–4.0 mm). There were no deaths. The dayolthe procedure, 3 patients had Q-wave MI that were ongoing at the time of stenting, 3 patients developed non Q-wave MI and 2 patients needed transfusion related to blood loss during the procedure. Between day one and discharge no patient had recurrent ischemia, no patient needed emergent revascularization, vascular repair or blood transfusion but one patient had elective CABG (2.4%). All patients were asymptomatic at discharge after 7.4 ± 3 days. During the subsequent 3 month follow-up no patient presented history of unstable angina, myocardial infarction, subacute thrombosis or emergent revascularization. One additional patient was referred for elective CABG (2.4%). Two patients developed rashes and ticlopidine was discontinued (4.9%). In regard to major clinical events, combined antiplatelet therapy using ticlopidine plus aspirin is a promising alternative to classical anticoagulant therapy to prevent delayed complications after successful stent implantation.