COMBINED ANTIPLATELET THERAPY WITH TICLOPIDINE AND ASPIRIN - A SIMPLIFIED APPROACH TO INTRACORONARY STENT MANAGEMENT

Intravascular metallic stents are increasingly used in the non-surgica l management of coronary atherosclerosis. Despite intensive anticoagul ation, subacute stent thrombosis, which usually has serious clinical c onsequences, and major haemorrhagic complications remain major problem s after stent implantation. In addition, conventional management with anticoagulant therapy requires prolonged hospitalization. In a prospec tive multicentre study, we investigated the efficacy of a combination of two antiplatelet agents, ticlopidine 500 mg daily and aspirin 200 m g daily, without oral anticoagulation after stent implantation. Since November 1993, 529 consecutive patients, in whom 545 vessels were succ essfully stented with conventional (non-heparin coated) stents have be en enrolled. Stenting was performed as a bailout procedure for failed angioplasty in 112 patients, for a suboptimal result after angioplasty in 314 patients, and electively in the remaining 103 patients. Corona ry events related, or possibly related, to stent thrombosis occurred i n 5.4% of patients stented as a bailout procedure and in 1.8% of patie nts stented for a suboptimal result. Serious bleeding complications oc curred in 5.4% of patients stented as a bailout procedure and 1.5% of patients stented for a suboptimal result. Neither stent thrombosis nor serious bleeding complications were seen in patients stented elective ly. Ticlopidine therapy was discontinued in 1.9% of patients due to ne utropenia (0.6%) or rash (1.3%). Mean hospital stay decreased from 6.1 6 +/- 2.14 days to 4.2 +/- 2.15 days during the study period. A combin ation of two antiplatelet agents can be employed in the vast majority of patients after coronary stent implantation. Subacute stent thrombos is rates and bleeding complications compare favourably with those repo rted using conventional therapy and the duration of hospitalization is reduced.