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Antiplatelet Is Superior to Anticoagulant Treatment After Coronary Stenting: Fewer Coronary and Other Events Within 30 Days After Stenting

Christodoulos Stefanadis, MD, FACC

Christoforos Olympios, MD

Vasilis Voudris, MD, FACC

Stavros Hatzimiltiadis, MD

Dimitriis Sionis, MD

Emmanouel Vavouranakis, MD

Antonis Vrahatis, MD

Constantine Fakiolas, MD

Evagellos Pissimisis, MD

Alexander Stefanidis, MD

Michael Zairis, MD

Gregory Pavlides, MD, FACC

Spyros Vitakis, MD

George Louridas, MD

Dennis Cokkinos, MD, FACC

Pavlos Toutouzas, MD, FACC

Stefanos Foussas, MD, FACC

Dept. of Cardiology Tzanio Hospital Afentouli and Zanni street Piraeus P.C: 185-36 Greece

Stent prosthesis is a high efficacious method with low complication rates. However, the ideal adjunctive therapy following stent implantation remains controversial. The authors compared the effectiveness and complication rates of aspirin-ticlopidine antiplatelet therapy vs anticoagulant therapy with acenocoumarol within 30 days following stent prosthesis. They prospectively studied 404 patients following stent prosthesis while randomly receiving anticoagulant (Group A: 201 patients) vs antiplatelet treatment (Group B: 203 patients). Groups A and B were similar in demographic data (age, gender), stent location, clinical presentation, indication of stenting, and type of implanted stent. Chi-square test, t test, and Wilcoxon test for two samples were used for statistical analysis of the results. Stent implantation was attempted in 434 cases. This was successful in 70/85 (82%) of the bailout, 122/135 (90%) of the suboptimal, and 212/214 (99%) of the elective cases. In 201 patients anticoagulant treatment with acenocoumarol was administered for 4 weeks (group A), while 203 received antiplatelet treatment with ticlo pidine (group B). The need for reintervention was less and total cardiac events were fewer in group B than in group A: three (1.5%) and nine (4.4%) vs 18 (9%) and 29 (14.4%), p < 0.0008 and p < 0.006 respectively. Hemorrhagic complications and total noncardiac events were fewer in group B than in group A: six (3%) and six (3%) vs 18 (9%) and 19 (9.5%), p < 0.01 and p < 0.007 respectively. The length of hospital stay was shorter in group B than in A, p < 0.0001. In conclusion, in this study of intracoronary stenting the authors had a high success rate in 434 attempted cases. Antiplatelet therapy was accompanied by fewer cardiac and noncardiac 1 month events when compared with anticoagulant therapy, supporting its role as the adjunctive treatment of choice post- stenting for the time being.

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