REDUCTION OF THROMBOTIC AND HEMORRHAGIC COMPLICATIONS AFTER STENT IMPLANTATION

This study compared two consecutive antithrombotic strategies after Pa lmaz-Schatz stent implantation and involved 918 patients. Patients tre ated between May 1991 and May 1994 (group 1; n=379) received aspirin, dipyridamole, and intravenous unfractionated heparin until oral antico agulation was effective, Between June 1994 and August 1995, 539 patien ts (group 2) were treated for 1 month with subcutaneous low-molecular- weight heparin (Fragmin), ticlopidine, and aspirin. There were no diff erences between the groups in terms of sex, clinical condition, vessel diameter, and severity and location of stenosis. Patients in group 1 were younger than those in group 2 (4% were > 70 years old compared wi th 12%, respectively; p < 0.01). Group 1 patients had more frequent un planned stenting (48% vs 18%, respectively; p < 0.01) and fewer endopr ostheses in the same artery than those in group 2 (1.1 +/- 0.5 vs 1.2 +/- 0.5, respectively; p < 0,01), Among group 2 patients, there was a significant reduction in thrombotic and hemorrhagic complications comp ared with group 1 patients. No subacute thrombosis occurred in patient s in group 2 in contrast with a 5.8% incidence in patients in group 1 (p < 0.01). In addition, a lower incidence of groin and systemic bleed ing was observed in patients in group 2 compared with patients in grou p 1 (2.6% vs 15%, respectively; P < 0.01), The association of low-mole cular-weight heparin and antiplatelets provides a simpler antithrombot ic strategy in patients treated with intracoronary stents and reduces the incidence of stent thrombosis and hemorrhagic complications. Our f indings suggest that this antithrombotic regimen may prevent or comple tely avoid stent thrombosis.