Outcome of patients on oral anticoagulation undergoing coronary artery stenting: data from discharge to 12 months in the Warfarin and Coronary Stenting (WAR-STENT) Registry
Andrea Rubboli, Francesco Saia, Alessandro Sciahbasi, Maria Letizia Bacchi-Reggiani, Luigi Steffanon, Carlo Briguori, Paolo Calabrò, Cataldo Palmieri, Andrea Rizzi, Ferdinando Imperadore, Giuseppe M Sangiorgi, Marco Valgimigli, Giuseppe Carosio, Giuseppe Steffenino, Marcello Galvani, Giuseppe Di Pasquale, Luigi La Vecchia, Aldo P Maggioni, Leonardo Bolognese, WARfarin and Coronary STENTing (WAR-STENT) Study Group, Andrea Rubboli, Giuseppe Di Pasquale, Giuseppe Steffenino, Stefano Mistrorigo, Luigi La Vecchia, Davide D'Andrea, Salvatore Grasso, Stefano Maggiolini, Alessandro Sciahbasi, Ernesto Lioy, Gianluca Caiazzo, Carlo Briguori, Nicoletta Franco, Giancarlo Piovaccari, Eloisa Basile, Antonio M Leone, Annamaria Nicolino, Sharham Moshiri, Stefano Mameli, Luigi Steffanon, Alberto Benassi, Pierpaolo Cannarozzo, Giuseppe Carosio, Paola Pasqualini, Silva Severi, Kenneth Ducci, Leonardo Bolognese, Alessandro Capecchi, Leonardo G Pancaldi, Luigi Vignali, Diego Ardissino, Francesco Saia, Barbara Bordoni, Antonio Marzocchi, Elisabetta Varani, Massimo Margheri, Giacomo Piccalò, Antonio Mafrici, Paolo Calabrò, Chiara Sordelli, Simona Boarin, Marcello Galvani, Pasquale Catanzariti, Flavio Tartagni, Michela Santi, Stefano Della Casa, Cataldo Palmieri, Francesco Bovenzi, Andrea Rizzi, Claudio Cuccia, Ferdinando Imperadore, Monia Monti, Marco Valgimigli, Paolo Magnavacchi, Michele Dallago, Roberto Bonmassari, Paolo Sbarzaglia, Claudio Cavallini, Enrico Russolillo, Simona Lambertini, Giuseppe M Sangiorgi, Paolo Rubartelli, Andrea Rubboli, Francesco Saia, Alessandro Sciahbasi, Maria Letizia Bacchi-Reggiani, Luigi Steffanon, Carlo Briguori, Paolo Calabrò, Cataldo Palmieri, Andrea Rizzi, Ferdinando Imperadore, Giuseppe M Sangiorgi, Marco Valgimigli, Giuseppe Carosio, Giuseppe Steffenino, Marcello Galvani, Giuseppe Di Pasquale, Luigi La Vecchia, Aldo P Maggioni, Leonardo Bolognese, WARfarin and Coronary STENTing (WAR-STENT) Study Group, Andrea Rubboli, Giuseppe Di Pasquale, Giuseppe Steffenino, Stefano Mistrorigo, Luigi La Vecchia, Davide D'Andrea, Salvatore Grasso, Stefano Maggiolini, Alessandro Sciahbasi, Ernesto Lioy, Gianluca Caiazzo, Carlo Briguori, Nicoletta Franco, Giancarlo Piovaccari, Eloisa Basile, Antonio M Leone, Annamaria Nicolino, Sharham Moshiri, Stefano Mameli, Luigi Steffanon, Alberto Benassi, Pierpaolo Cannarozzo, Giuseppe Carosio, Paola Pasqualini, Silva Severi, Kenneth Ducci, Leonardo Bolognese, Alessandro Capecchi, Leonardo G Pancaldi, Luigi Vignali, Diego Ardissino, Francesco Saia, Barbara Bordoni, Antonio Marzocchi, Elisabetta Varani, Massimo Margheri, Giacomo Piccalò, Antonio Mafrici, Paolo Calabrò, Chiara Sordelli, Simona Boarin, Marcello Galvani, Pasquale Catanzariti, Flavio Tartagni, Michela Santi, Stefano Della Casa, Cataldo Palmieri, Francesco Bovenzi, Andrea Rizzi, Claudio Cuccia, Ferdinando Imperadore, Monia Monti, Marco Valgimigli, Paolo Magnavacchi, Michele Dallago, Roberto Bonmassari, Paolo Sbarzaglia, Claudio Cavallini, Enrico Russolillo, Simona Lambertini, Giuseppe M Sangiorgi, Paolo Rubartelli
Abstract
Objectives: To obtain further, and more focused, information on the efficacy and safety of the antithrombotic regimens, including triple therapy (TT) of warfarin, aspirin, and clopidogrel; dual therapy (DT) of warfarin and single antiplatelet agent (aspirin or clopidogrel); and dual-antiplatelet therapy (DAPT) of aspirin and clopidogrel, prescribed to patients on oral anticoagulation (OAC) undergoing percutaneous coronary intervention with stent (PCI-S).
Background: The true efficacy and safety of TT, DT, and DAPT in OAC patients undergoing PCI-S is largely undefined.
Methods: We analyzed the database of the prospective, multicenter WARfarin and coronary STENTing (WAR-STENT) registry (ClinicalTrials.gov identifier NCT00722319), only including the post-discharge period.
Results: Of the 401 patients discharged alive from index hospitalization, 339 (85%), 20 (5%), and 42 (10%) were prescribed TT, DT, and DAPT, respectively. Throughout a mean follow-up of 368.3 ± 22.8 days, major adverse cardiovascular events (MACE) (including cardiovascular death, myocardial infarction, repeat revascularization, stent thrombosis, and thromboembolism), total bleeding, major bleeding, and combination of MACE plus total bleeding were comparable across the three treatment groups. The absolute rate of major bleeding with TT was 4%. The antithrombotic treatment actually ongoing at major bleeding was TT in 44%, DT in 50%, and DAPT in 6% of cases.
Conclusion: In the real-world population of OAC patients undergoing PCI-S in the WAR-STENT registry, the three antithrombotic regimens of TT, DT, and DAPT showed comparable efficacy and safety. Due to several limitations, our data cannot be considered conclusive in confuting the current recommendations to prescribe TT. Further properly designed and sized studies are warranted.
Source: PubMed