CLINICAL OUTCOME AT 6 MONTHS OF CORONARY STENTING FOLLOWED BY TICLOPIDINE MONOTHERAPY

Antiplatelet therapy has been shown to be superior to oral anticoagula tion after coronary stent implantation. Different regimens for postint erventional antiplatelet therapy have been proposed. A combination of ticlopidine and aspirin has gained the most widespread use. The relati ve merit of the different compounds in this combination remains unclea r. There are several, partly conflicting, reports on coronary stent im plantation followed by aspirin alone, but data on ticlopidine monother apy are scarce. We conducted a prospective trial of elective coronary stenting followed by ticlopidine monotherapy in 263 consecutive, unsel ected patients. One-, 2-, and 3-vessel disease was present in 42.9%, 4 2.6%, and 14.5% of patients, respectively. We deployed a total of 322 stents. All patients received 250 mg of ticlopidine twice daily for up to 6 months. The clinical end paints encountered during the hospital stay and at 5.9 +/- 2.9 months, respectively, were: death (2 [0.8%] an d 2 [0.8%]); myocardial infarction (5 [1.9%] and 4 [1.5%]); target ves sel occlusion (2 [0.8%] and 4 [1.5%]); bypass surgery (0 and 2 [0.8%]) ; and repeat angioplasty (2 [0.8%] and 52 [19.8%]). There was 1 vascul ar surgery (0.4%) and 4 (1.5%) non-procedure-related ischemic cerebrov ascular events at follow-up. We conclude that coronary stent deploymen t followed by ticlopidine monotherapy is safe and effective in an unse lected population. The overall clinical outcome at 6 months is good an d comparable to that of patients treated with combined antiplatelet th erapy. Ticlopidine monotherapy may be a safe alternative for patients with contraindications to aspirin. (C) 1998 by Excerpta Medica, Inc.