Abstract 3474: Bleeding Complications Associated with Dual Antiplatelet Therapy plus Anticoagulant in Patients Who Underwent Percutaneous Coronary Intervention with Drug-eluting Stents

Abstract

Backgrounds: Combinations of dual antiplatelet therapy (aspirin with thienopyridine derivatives) plus warfarin sodium are often used in various cardiac conditions. The purpose of this study was to evaluate bleeding complications associated with combinations of dual antiplatelet plus anticoagulant therapy in patients who underwent percutaneous coronary intervention (PCI) with drug eluting stents (DES). Methods and Results : We reviewed 563 PCI cases with DES between August 2004 and March 2007 in our hospital either in the setting of elective situation or acute coronary syndrome. On discharge, 515 patients (91.5%) were prescribed dual antiplatelet therapy alone, while 48 patients (8.5%) were discharged receiving dual antiplatelet plus anticoagulant therapy. Major and minor bleeding complications were observed in 90 patients (17.8%). Rates of bleeding complications were significantly higher among patients receiving triple therapy compared to those with dual antiplatelet alone (37.5% vs. 13.9%, P<0.05). Moreover, incidence of major bleeding was remarkably higher in patients receiving the triple therapy compared to those with dual antiplatelet alone (16.7% vs. 1.9%, P<0.01). Multivariate analysis revealed that chronic kidney disease (CKD) is a strongest predictor of both major and minor bleeding. Conclusions : Triple therapy, dual antiplatelet plus anticoagulant combination, was associated with significant increase in bleeding risk for patients who underwent PCI with DES. Our results also suggest that caution should be paid especially in those patients with CKD, that is a strongest predictor of major bleeding when the triple antithrombotic regimen was prescribed.