CORONARY-ARTERY STENTING WITHOUT ORAL ANT ICOAGULATION

This paper reports experience with a new antithrombotic agent prescrib ed to reduce the incidence of subacute occlusions during the first mon th after coronary stenting. Therefore, a powerful association of plate let antiaggregant agents was tested. From December 1992 to October 199 4, coronary stenting was successfully achieved in 1 294 patients (1 11 8 men, average age 60.5 +/- 10 years) who were then treated with the a ssociation of ticlopidine 0.25 g/day and aspirin 0.10 g/day for one mo nth. This was covered with anticoagulation with a low molecular weight heparin for a variable perid (one month, two weeks, then one week), a ccording to the different phases of the study protocol. In all, 1487 s tents were successfully implanted (1 330 Palmaz Schatz: 63 Cook: 80 Wi ctor : 13 AVE and 1 Strecker) in 1 326 vessels (520 left anterior desc ending, 208 left circumflex, 475 right coronary, 16 left main coronary arteries and 107 venous grafts) using balloon catheters of 2.5 mm to 5 mm diameter for average 3.45 +/- 0.4 mm). Major complications in the first month included 9 deaths (0.7%), 22 occlusions (1.7%) : 14 myoca rdial infarcts (1%) and 11 aorto-coronary bypass procedures (0.85%). T here were 136 local haematomas or false aneurysms (10.5%), 42 of which (3.25%) required blood transfusion or surgical repair. This multicent er trial of a protocol associating platelet antiaggregant agents and l ow molecular weight heparin for one month showed a low incidence of su bocclusion after coronary stenting (1.7 +/- 2.5%) and should enable in terventional cardiologists to widen the indications for coronary stent ing.