INFLUENCE OF DIFFERENT ANTITHROMBOTIC THE RAPIES ON THE INCIDENCE OF SUBACUTE CORONARY STENT OCCLUSIONS, HEMORRHAGIC COMPLICATIONS AND LENGTH OF IN-HOSPITAL STAY

Background: The clinical benefit of coronary stenting is reduced by th e risk of thrombotic stent occlusion as well as hemorrhagic complicati ons of intensive antithrombotic therapy We compared the influence of d ifferent antithrombotic therapies on the incidence of postintervention al complications and in-hospital stay duration. Methods: After success ful placement of a coronary stent, 334 consecutive patients were given different antithrombotic treatments in addition to aspirin 100 mg/d i ndefinitely: (1) phenprocoumon for 3 months (n = 47), (2) low molecula r weight heparin 2 x 100 U/kg/d s.c. for 4 weeks (n = 90), (3) ticlopi dine 2 x 250 mg/d and low molecular weight heparin 2 x 100 U/kg/d s.c. for 4 weeks (n = 72) and (4) ticlopidine 2 x 250 mg/d for 4 weeks (n = 125). Results: Major events were subacute stent thrombosis in 17 pat ients (5%), and severe hemorrhagic complication in 20 patients (5,9%). The incidence of subacute stent thrombosis in groups 1 to 4 was 10.6% , 11%, 1.4% and 0.8% respectively. The use of ticlopidine was associat ed with a significant lowering of stent occlusions in univariate and m ultivariate analysis (p = 0.0013). Additional uni- and multivariate pr edictors were stent placement as a ''bail-out'' procedure (p = 0.033) and in patients with acute coronary syndrome (p = 0.049). Anticoagulan t therapy was associated with a higher incidence of severe hemorrhagic complications (p < 0.01) and a prolonged in-hospital stay (p = 0.01). Conclusions: These results confirm that antithrombotic therapy with a spirin and ticlopidine combines low rates of subacute stent occlusion and hemorrhagic complications. Treatment with phenprocoumon and low mo lecular weight heparin does not improve the rate of subacute stent sec lusion but increases hemorrhagic complications. Very low rates of sten t occlusion permit short in-hospital stays with concomitant reduction in cost.