Antithrombotic therapy after coronary stenting in patients with indication for oral anticoagulation: Reply

Abstract

We appreciated the comments of Manzano Fernandez et al. [ [1] Manzano Fernandez S. Caro Martinez C. Cambronero Sànchez F. Pastor Perez F.J. Marin Ortuňo F. Valdès-Chavarri M. Antithrombotic therapy after coronary stenting in patients with indication for oral anticoagulation. Int J Cardiol. 2008; Google Scholar ] to our recent article reviewing the evidence on and providing suggestions for the antithrombotic therapy for patients on oral anticoagulation who undergo coronary artery stent implantation [ [2] Rubboli A. Verheugt F.W.A. Antithrombotic treatment for patients on oral anticoagulation undergoing coronary stenting. A review of the available evidence and practical suggestions for the clinician. Int J Cardiol. 2008; 123: 234-239 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar ]. Also, the additional data on this, still unaddressed, issue provided by Manzano Fernandez et al. [ [1] Manzano Fernandez S. Caro Martinez C. Cambronero Sànchez F. Pastor Perez F.J. Marin Ortuňo F. Valdès-Chavarri M. Antithrombotic therapy after coronary stenting in patients with indication for oral anticoagulation. Int J Cardiol. 2008; Google Scholar ] are of value, in that they confirm a substantial variability (even at a same center) in the medium-term antithrombotic management of this patient subset, being however triple therapy with an oral anticoagulant, aspirin and clopidogrel the most frequent strategy. The advanced age of this patient population, and the high prevalence of relevant co-morbidities, is also confirmed, as well as atrial fibrillation being the foremost indication for long-term anticoagulation. Although not substantiated by own outcome data, the suggestions for clinical practice given by Manzano Fernandez et al. [ [1] Manzano Fernandez S. Caro Martinez C. Cambronero Sànchez F. Pastor Perez F.J. Marin Ortuňo F. Valdès-Chavarri M. Antithrombotic therapy after coronary stenting in patients with indication for oral anticoagulation. Int J Cardiol. 2008; Google Scholar ] reflect common sense and are lined up with most of the recommendations of the literature [ 2 Rubboli A. Verheugt F.W.A. Antithrombotic treatment for patients on oral anticoagulation undergoing coronary stenting. A review of the available evidence and practical suggestions for the clinician. Int J Cardiol. 2008; 123: 234-239 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar , 3 Helft G. Gilard M. Le Feuvre C. Zaman A.G. Drug insight: antithrombotic therapy after percutaneous coronary intervention in patients with an indication for oral anticoagulation. Nat Clin Pract Cardiovasc Med. 2006; 3: 673-680 Crossref PubMed Scopus (30) Google Scholar , 4 Lip G.Y.H. Karpha M. Anticoagulant and antiplatelet therapy use in patients with atrial fibrillation undergoing percutaneous coronary intervention: the need for consensus and a management guideline. Chest. 2006; 130: 1823-1827 Crossref PubMed Scopus (83) Google Scholar ]. The adoption of triple therapy appears in fact, the best option unless a high hemorrhagic risk is present. In such a case, the combination of oral anticoagulation and a single antiplatelet agent is probably the most reasonable alternative. Avoidance of drug-eluting stent implantation also needs to be pursued in order to decrease the duration of a combined treatment with an oral anticoagulant, aspirin and clopidogrel, therefore reducing the likelihood of bleeding events.