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Early and late increased bleeding rates after angioplasty and stenting due to combined antiplatelet and anticoagulanttherapy

Hälg, Christophe and Brunner-La Rocca, Hans Peter and Kaiser, Christoph and Jeger, Raban and Osswald, Stefan and Pfisterer, Matthias and Hoffmann, Andreas. (2009) Early and late increased bleeding rates after angioplasty and stenting due to combined antiplatelet and anticoagulanttherapy. EuroIntervention : official journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), Vol. 5. pp. 425-431.

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Official URL: http://edoc.unibas.ch/dok/A6005009

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Abstract

AIMS: To assess major bleeding complications in patients after coronary stenting who are on dual antiplatelet drugs with or without oral anticoagulants. METHODS AND RESULTS: Bleeding complications necessitating hospital admission were prospectively recorded during initial hospitalisation and during a complete follow-up of three years in 813 consecutive patients undergoing coronary artery stenting. All patients were assigned to antiplatelet therapy with aspirin and clopidogrel for at least six months and continued aspirin use thereafter. There were 25 early bleedings and 26 late hospital admissions for bleeding. Forty-four patients (5.4%) were on oral anticoagulants (coumadin) in addition to antiplatelet agents. The rate of late severe bleeding was 6.1% per year with, vs. 0.8% without coumadin (p >0.0001). In multivariate analyses GPIIb/IIIa (OR 3.8 95%-CI 1.6-8.8, p=0.002), female gender (=R 2.5, 95%CI 1.1-5.8, p=0.04) and age (OR 1.44 per decade, 95%CI 0.99-2.08, p=0.05) were independent predictors of early bleeding; and LVEF (OR 0.65 per 10% increase, 95%CI 0.48-0.87, p=0.004), history of malignancy (OR 5.1, 95%CI 1.5-17.0, p=0.009) and coumadin use (OR 3.5,95%CI 1.1-11.5, p=0.04) for late bleeding. CONCLUSIONS: For patients on oral anticoagulants, drug eluting stents necessitating sustained dual antiplatelet therapy should be used with caution. Specific risk factors for bleeding complications should guide anticoagulation after PCI.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Kardiologie (Pfisterer)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Kardiologie (Pfisterer)
UniBasel Contributors:Hoffmann, Andreas and Pfisterer, Matthias E. and Kaiser, Christoph A. and Jeger, Raban
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Europa Ed.
ISSN:1774-024X
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:24 May 2013 09:22
Deposited On:24 May 2013 09:04

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