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741-2 Full Antiplatelet Therapy without Anticoagulation After Coronary Stenting

1995; Elsevier BV; Volume: 25; Issue: 2 Linguagem: Inglês

10.1016/0735-1097(95)92213-o

1558-3597

Jean‐Marc Lablanche, Gilles Grollier, Nicolas Danchin, J Bonnet, Éric Van Belle, Eugène Mc Fadden, Michel E. Bertrand,

Healthcare Systems and Practices

Subacute thrombosis remains a major limitation of coronary stenting. In addition, local complications related to the intensive anticoagulation that is commonly employed are frequent. We prospectively studied a regime of intensive antiplatelet therapy (aspirin 200 mg daily begun before percutaneous transluminal coronary angioplasty, ticlodipine 500 mg daily for 3 months begun just after angioplasty) with periprocedural dextran infusion continued for a period at the discretion of the local investigator. To date, 98 patients (85 men, 13 women) undergoing 102 procedures involving 125 stents have been enrolled; 71 patients had one stent implanted; 19 patients had 2 stents implanted, and 2 patients had 3 stents implanted. Symptoms before coronary angioplasty included effort angina (23%), angina at rest (6%), unstable angina (23%), recent myocardial infarction (27%). The indications for stent implantation were occlusive dissection 36%, dissection without occlusion 32%, suboptimal result or elective implantation 32%. The stented site was the LAD (37%). RCA (35%). LCx (17%), and vein graft (11%). Stent types were Wiktor (70%), Palmaz-Schatz (23%). Gianturco-Roubin (7%). The diameter of the stents implanted was 2.5 mm (2%), 3.0 mm (32%), 3.5 mm (44%), and 4.0 mm (22%). There were 2 deaths; 1 patient died from cardiogenic shock that was present before stent implantation 1 patient commited suicide; 4 patients developed q-wave AMI, 1 was already complete at the time of stent implant. 3 occurred In the hours after stent implant for occlusive dissection; 8 patients had non-O AMI; 3 patients had CABG, 1 at 5 hours post stent for reocclusion (non-O wave AMI), 2 were performed electively without sequelae for an unsatisfactory angiographic result but without ongoing ischemia. Blood transfusion for periprocedural blood loss was needed in 2 patients. No coronary event occurred between 48h and discharge, or during follow-up. Local complications occurred in 4 patients (surgical repair 1, blood transfusion 2, false aneurysm1). In this early experience, no subacute closure occurred after bailout or elective stenting using intense anti platelet therapy. Such an approach appears safe and may permit much earlier patient discharge.