ANTIPLATELET THERAPY ALONE IS SAFE AND EFFECTIVE AFTER CORONARY STENTING - OBSERVATIONS OF A TRANSITION IN PRACTICE

OBJECTIVE: To evaluate the safety and efficacy of transition in practi ce after coronary stenting to antiplatelet therapy alone compared with anticoagulation with warfarin. DESIGN: Retrospective analysis of coro nary stent management in a tertiary Canadian centre. PATIENTS: A total of 136 consecutive patients (146 lesions) were analyzed who underwent Palmaz-Schatz coronary stenting over a 15-month period and were treat ed with anticoagulation with warfarin (56 patients) or antiplatelet th erapy alone with ticlopidine and acetylsalicylic acid (80 patients) du ring the transition in poststenting therapy in the authors' practice. Treatment was continued for 30 days in both groups. High pressure sten t deployment was used in the majority of cases (greater than 90%), and use of intravascular ultrasound was infrequent (less than 12%). MAIN RESULTS: At 30 days, there were no clinical manifestations of stent th rombosis, coronary artery bypass surgery or repeat angioplasty in eith er group. One death occurred in the antiplatelet group. Periprocedural non-Q wave myocardial infarction occurred in two patients in the anti platelet group and in one patient in the warfarin group. There was a s ignificantly higher incidence of vascular complications in the warfari n group than in the antiplatelet group (14.3% versus 2.5%, respectivel y, P=0.04). The length of hospital stay was significantly shorter in t he antiplatelet group than in the warfarin group (3.0+/-1.8 versus 6.7 +/-2.6 days, respectively, P<0.001). CONCLUSIONS: Reduced anticoagulat ion with antiplatelet therapy alone after coronary stenting, despite i nfrequent use of intravascular ultrasound, is an effective and safe st rategy with a low rate of vascular complications, a relatively short h ospital stay and a low incidence of clinical manifestations of stent t hrombosis.