Effect of coumarins started before coronary angioplasty on acute complications and long-term follow-up - A randomized trial

Background-Coronary angioplasty frequently creates a thrombogenic surface, with subsequent mural thrombosis that may lead to acute complications and p ossibly stimulates the development of restenosis. Whether coumarins can pre vent these complications is unclear. The objective of this open, randomized trial was to assess the clinical effect of coumarins started before corona ry angioplasty and continued for 6 months. Methods and Results-Before coronary angioplasty, 530 patients were randomly assigned to aspirin plus coumarins and 528 patients to aspirin alone. At t he start of the angioplasty, the mean international normalized ratio was 2. 7+/-1.1; during follow-up, it was 3.0+/-1.1. At 30 days, the composite end point of death, myocardial infarction, target-lesion revascularization, and stroke was observed in 18 patients (3.4%) treated with aspirin plus coumar in compared with 34 patients (6.4%) treated with aspirin alone (relative ri sk, 0.53; 95% CI, 0.30 to 0.92). At 1 year, these figures were 14.3% and 20 .3%, respectively (relative risk, 0.71; 95% CI, 0.54 to 0.93). The incidenc e of major bleeding and false aneurysm during hospitalization was 3.2% and 1.0%, respectively (relative risk, 3.39; 95% CI, 1.26 to 9.11). The benefit of coumarins was observed in both stented and nonstented patients. Conclusions-Coumarins in addition to aspirin started before PTCA and contin ued for 6 months was more effective than aspirin alone in the prevention of acute and late complications after coronary angioplasty. This benefit was accompanied by a small but significant increase in bleeding complications.