SUBACUTE OCCLUSION, BLEEDING COMPLICATIONS, HOSPITAL STAY AND RESTENOSIS AFTER PALMAZ-SCHATZ CORONARY STENTING UNDER A NEW ANTITHROMBOTIC REGIMEN

Objectives. This study was designed to evaluate the effect of an antit hrombotic regimen without full early anticoagulation on subacute occlu sion, bleeding, hospital stay and restenosis after elective coronary s tenting. Background. Subacute occlusion is a major limitation of stent ing. Aggressive antithrombotic therapy is not fully prophylactic again st this complication, carries risk of bleeding, prolongs hospital stay and reduces cost effectiveness. Methods. We studied 110 consecutive p atients (121 lesions) who underwent elective Palmaz-Schatz stenting. I ntravenous heparin was given only during the procedure. After stenting , patients took aspirin, dipyridamole, dextran, warfarin and low molec ular weight heparin (enoxaparin, 40 mg subcutaneously daily, stopped w hen an international normalized ratio of 2 to 3 was achieved). The fir st 52 patients (group A) underwent coronary angiography 24 h after ste nting, and hospital stay was extended until an international normalize d ratio of 2 to 3.5 was achieved. The remaining 58 patients (group B) were discharged 24 h after stenting. Clinical and angiographic follow- up were performed 1 and 6 months after stenting for all patients. Resu lts. In group A the activated partial thromboplastin time remained nor mal (30 +/- 6.2 s [mean +/- SD]) during enoxaparin administration, and hospital stay was 9.1 +/- 4.3 days. In group B hospital stay was 27 /- 8 h. No major cardiac events occurred within the first month in pat ients from both groups. At 1 and 30 days all stented lesions remained patent. Only two patients (1.8%, 95% confidence interval [CI] 0.32% to 7%) developed bleeding, At 6 months, the restenosis rate was 22% (95% CI 15% to 30%). Conclusions. After coronary stenting with optimal ang iographic results, this new antithrombotic regimen prevented subacute stent occlusion and bleeding, with a brief hospital stay. No detriment al effect on the previously reported restenosis rate was observed.