Oral anticoagulant therapy during and after coronary angioplasty - The intensity and duration of anticoagulation are essential to reduce thrombotic complications
Jm. Ten Berg et al., Oral anticoagulant therapy during and after coronary angioplasty - The intensity and duration of anticoagulation are essential to reduce thrombotic complications, CIRCULATION, 103(16), 2001, pp. 2042-2047
Citations number
26
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-In the randomized Balloon Angioplasty and Anticoagulation Study
(BAAS), the addition of oral anticoagulants to aspirin significantly reduce
d early and late events after coronary angioplasty. However, bleeding episo
des were increased, The present report studied the intensity and the durati
on of anticoagulation as predictors of thrombotic and bleeding events.
Methods and Results-A, total of 530 patients, 34% of whom received a stent,
were treated with aspirin plus coumarins. Half of the patients were random
ized to angiographic follow-up. The target international normalized ratio (
INR) was 2.1 to 4.8 during angioplasty and 6-month follow-up. Thrombotic ev
ents were death, myocardial infarction, target lesion revascularization, an
d thrombotic stroke. Bleeding complications were hemorrhagic stroke, major
extracranial bleeding, and false aneurysm. "Optimal" anticoagulation was de
fined as an INR in the target range for at least 70% of the follow-up time.
There were 17 early thrombotic events (3.2%), 7 early bleeding episodes (1
.3%) and 10 false aneurysms (1.9%). The incidence rate for both early throm
botic and bleeding events was lowest in patients in the target range. A tot
al of 61 late thrombotic events occurred (11.6%). Optimal anticoagulation w
as an independent predictor of late thrombotic events (relative risk, 0.33;
95% CI, 0.19 to 0.57) and was associated with a 0.21 mm (95% CI, 0.17 to 0
.42) larger vessel lumen at 6 months. Late bleeding episodes (1.4%) were lo
west in patients in the target range.
Conclusions-Coumarins started before coronary angioplasty with a target INR
of 2.1 to 4.8 led to the lowest procedural event rate, without an increase
in bleeding episodes. During follow-up, optimal anticoagulation was associ
ated with a decrease in the incidence of late events by 67% and a significa
nt improvement in 6-month angiographic outcome.