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Short‐term triple therapy with aspirin, warfarin, and a thienopyridine among patients undergoing percutaneous coronary intervention
Author(s) -
Porter Avital,
Konstantino Yuval,
Iakobishvili Zaza,
Shachar Leeor,
Battler Alexander,
Hasdai David
Publication year - 2006
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20733
Subject(s) - medicine , warfarin , conventional pci , aspirin , percutaneous coronary intervention , surgery , thienopyridine , cardiology , clopidogrel , angioplasty , atrial fibrillation , myocardial infarction
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. © 2006 Wiley‐Liss, Inc.