Key result
Short-term triple therapy with warfarin, aspirin, and a thienopyridine after PCI was associated with an 11.1% rate of bleeding complications (2 major, 18 minor).
Why the study?
Does short-term triple therapy with aspirin, warfarin, and a thienopyridine cause prohibitively high bleeding complications in post-PCI patients?
Cohort (n=180)
Does short-term triple therapy with aspirin, warfarin, and a thienopyridine cause prohibitively high bleeding complications in post-PCI patients?
Short-term (30-day) triple therapy with aspirin, warfarin, and a thienopyridine post-PCI had acceptable bleeding rates, suggesting it can be considered when warfarin is clearly indicated.
Answers are grounded in this paper and cite their sources.
May reinforce bleeding caution with triple therapy post-PCI; leaves open optimal regimens pending randomized data.
OBJECTIVES: To assess bleeding complications among patients undergoing percutaneous coronary intervention (PCI) and receiving triple therapy of warfarin, aspirin, and a thienopyridine. BACKGROUND: Triple therapy of warfarin, aspirin, and a thienopyridine is strongly discouraged, given the potential risk of bleeding complications. METHODS AND RESULTS: Post-PCI patients receiving triple therapy thereafter underwent assessment for bleeding complications. Continuous variables are presented as median (25th-75th percentiles). The study group included 180 patients (80% males; age 65 (52, 75.5)). PCI was on an urgent/emergent basis in 86.6%. The main indications for warfarin use were left ventricular mural thrombus and atrial fibrillation (46.9 and 36.9% respectively). Glycoprotein IIb/IIIa receptor antagonists were used in 47.7%. Post-PCI triple therapy duration was 30 days (30, 30). During the post-triple therapy, 104 patients (57.8%) continued treatment with warfarin and aspirin for 376 days (150, 775). During the triple therapy period, 20 patients developed bleeding complications, (mean INR 2.1 +/- 0.7 at 7 (6, 8.5) days post-PCI): 2 major groin hematoma (initial phase of warfarin treatment during overlap with heparin) and 18 minor. During post-triple therapy, primarily under warfarin and aspirin, 19 patients developed bleeding complications: 1 major and 18 minor. CONCLUSION: Short-term triple therapy after PCI was not associated with prohibitively high bleeding complication rates, and thus should be favorably considered in patients with a clear indication for warfarin use.
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Porter et al. (2006) conducted a cohort in percutaneous coronary intervention (n=180). Triple therapy (warfarin, aspirin, thienopyridine) was evaluated on bleeding complications. Short-term triple therapy with warfarin, aspirin, and a thienopyridine after PCI was associated with an 11.1% rate of bleeding complications (2 major, 18 minor).
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