951-70 Absence of Bleeding and Subacute Occlusion After Palmaz-Schatz Coronary Stenting Using a New Antithrombotic Regimen

Abstract

Subacute thrombotic occlusion and bleeding complications related to antithrombotic therapy are the major limitations of elective coronary stenting. The effectiveness of a new antithrombotic regimen without full early anticoagulation to prevent these complications has been evaluated in 52 consecutive pts (62 ± 11 years, 82% male) who underwent elective Palmaz-Schatz stenting in 58 lesions. Four lesions were restenotic and 3 lesions were located in venous graft. The mean reference diameter was 3.3 ± 0.6 mm, with a mean diameter stenosis of 71 ± 9%. Intravenous heparin was given only during the procedure. After stenting, the pts were treated with aspirin, dipyridamole, dextran, warfarin and subcutaneous low molecular weight heparin (LMWH) [enoxaparine, 40 mg/day]. LMWH was started 6 h after stenting and stopped when an INR of 2–3 was achieved, The aPTI and the INR were determined daily before discharge. In all pts, serial quantitative angiographic follow-up (FU) study was performed at 24 hours, 30 days and 6 months after stenting. Optimal angiographic stent result was achieved in 98% of the lesions, and minimal lumen diameter (MLD) increased from 1.2 ± 0.4 to 3.6 ± 0.5 mm (p < 0.001). The aPTI remained normal (mean: 32 ± 5.6 sec, range: 24 to 48 sec) during LMWH administration; and an INR >2 was achieved 3 days after intervention in 94% of stented pts. Neither an event (myocardial infarction. coronary surgery or death) nor major bleeding occurred during the first month. At 24 hand 1 month angiographic FU, all stented lesions remained patent, with no significant changes in MLD. At 6 months FU, all stented arteries remained patent, MLD decreased significantly to 2.5 ± 0.8 mm (p < 0.001), and a restenosis rate of 23% (95% CI: 13–36%) of stented lesions (stenosis ≥50% criteria) was observed. These data suggest that, after elective stenting with optimal angiographic result, the initial combination of LMWH (with no significant effect on aPTT) plus anti platelet therapy, followed by anticoagulation with coumadin, prevent subacute occlusion and bleeding complications, without detrimental effect on previous reported restenosis rate.