Safety and efficacy of ticlopidine for only 2 weeks after successful intracoronary stent placement

Background-In patients receiving intracoronary stents, stent thrombosis is reduced when ticlopidine therapy is combined with aspirin after the procedu re. However, ticlopidine causes neutropenia in 1% of patients when administ ered for >2 weeks, and little is known about the duration that ticlopidine needs be administered to prevent stent thrombosis. Methods and Results-We analyzed 827 patients undergoing successful stent pl acement in 1061 coronary segments at Mayo Clinic who were treated between M ay 1, 1996, and October 31, 1997. Chronic warfarin therapy, cardiogenic sho ck, and enrollment in research protocols requiring 4 weeks of ticlopidine w ere exclusion criteria; ticlopidine was discontinued after 14 days in all r emaining patients. The mean age of the study population was 64 +/- 11 years ; 49% had suffered a prior infarction, 20% had undergone coronary artery by pass surgery, and 65% had multivessel disease. The indication for stent pla cement was dissection or abrupt closure in 31% of patients and suboptimal r esults from balloon angioplasty in 18%. Placement was elective in 51% of pa tients, and 10.3% of patients were treated within 12 hours of an acute myoc ardial infarction. Mean nominal stent size was 3.3 +/- 0.5 mm. High-pressur e inflations (greater than or equal to 12 atm) were performed in all patien ts (mean, 17 +/- 4 atm). Intravascular ultrasound was used to facilitate st ent placement in 8.8% of patients. Abciximab was administered to 38% of pat ients; 11% of patients who were at increased risk of stent thrombosis were treated with enoxaparin for 10 to 14 days. Adverse cardiovascular events in the 14 days after stent placement occurred in II patients (1.3%). Two pati ents died of nonischemic causes (sepsis and renal failure) in the 15th thro ugh 30th days after ticlopidine was stopped. However, there were no cardiov ascular deaths, myocardial infarctions, coronary artery bypass operations, or repeat angioplasty procedures between the 15th and 30th days; stent thro mbosis did not occur in any patient after ticropidine had been stopped. No patient developed neutropenia, although 1.8% of the first 489 patients who were closely monitored for side effects from ticlopidine developed side eff ects requiring its discontinuation, and milder side effects occurred in 4.7 %. Conclusions-In patients receiving intracoronary stents, the discontinuation of ticlopidine therapy 14 days after stent placement is associated with a very low frequency of stent thrombosis and other adverse events.