November 25, 2009Catheterization and Cardiovascular Interventions
Safety of drug eluting stents in patients on chronic anticoagulation using long‐term single antiplatelet treatment with clopidogrel
Why the study?
Does the use of drug eluting stents compared to bare metal stents reduce major adverse coronary events and major bleedings in patients requiring chronic anticoagulation treated with long-term single antiplatelet therapy (clopidogrel)?
Population
165 consecutive patients requiring chronic anticoagulation undergoing coronary stenting. DES group: mean age…
Comparison
Drug eluting stents with 4 weeks of aspirin +… vs Bare metal stents with 4 weeks of aspirin +…
Design
Cohort
Follow-up
12 months
Authors
Discussion
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Implication
DES use was associated with lower MACE in anticoagulated patients on clopidogrel monotherapy; hypothesis-generating and should not yet change practice.
Key Points
- To assess the clinical safety and efficacy of drug-eluting stents compared to bare metal stents in patients requiring chronic oral anticoagulation managed with long-term clopidogrel monotherapy.
- Enrolled 165 consecutive anticoagulated patients receiving either drug-eluting stents (DES, N=79) or bare metal stents (BMS, N=86).
- All patients received aspirin, clopidogrel, and oral anticoagulants for 4 weeks, followed by clopidogrel plus anticoagulants through 12-month follow-up.
- Evaluated the primary composite endpoint of major adverse coronary events and major bleeding at 12 months.
- The primary composite endpoint occurred in 10.1% of DES patients versus 26.7% of BMS patients (P = 0.01; multivariate HR 0.35, 95% CI 0.14–0.85, P = 0.02).
- Target vessel revascularization was significantly lower in the DES group (8.1%) compared to the BMS group (23.3%, P = 0.01), with no stent thrombosis observed in either arm.
- Rates of myocardial infarction (3.8% with DES vs. 8.1% with BMS) and major bleeding (1.3% vs. 2.3%, respectively) were not significantly different.
Structured PICO
Does the use of drug eluting stents compared to bare metal stents reduce major adverse coronary events and major bleedings in patients requiring chronic anticoagulation treated with long-term single antiplatelet therapy (clopidogrel)?
P
Population
165 consecutive patients requiring chronic anticoagulation undergoing coronary stenting (79 DES, 86 BMS). DES group: mean age 67, 84% with atrial fibrillation. BMS group: mean age 70, 71% with atrial fibrillation.
I
Intervention
Drug eluting stents (DES) with 4 weeks of aspirin + clopidogrel + oral anticoagulants, followed by clopidogrel + oral anticoagulants for 12 months.
C
Comparator
Bare metal stents (BMS) with 4 weeks of aspirin + clopidogrel + oral anticoagulants, followed by clopidogrel + oral anticoagulants for 12 months.
O
Outcome
Combined incidence of major adverse coronary events and major bleedings at 12-month follow-up.composite
In patients requiring chronic anticoagulation, using DES with 4 weeks of triple therapy followed by clopidogrel and anticoagulation significantly reduced MACE and bleeding compared to BMS.
Cite This Study
Pasceri et al. (2009) studied this question.