REDUCED ANTICOAGULATION WITH ANTIPLATELET THERAPY ALONE IS SAFE AND EFFECTIVE AFTER BAIL-OUT STENTING FOR FAILED ANGIOPLASTY

The aim of this retrospective study was to compare the safety and effi cacy of antiplatelet therapy alone with conventional anticoagulation w ith warfarin after ''bail-out'' coronary stenting for failed balloon a ngioplasty at a tertiary referral centre. Eighty-two consecutive patie nts undergoing ''bail-out'' stenting over a 22-month-period were studi ed. Forty patients received antiplatelet therapy alone with aspirin an d ticlopidine and 42 patients received anticoagulation with warfarin f or 30 days. The main outcome measures examined were death, myocardial infarction, coronary artery bypass surgery, repeat angioplasty, and si gnificant vascular complications. The angiographic procedural success rate was 100% in both groups. At six weeks there were no deaths and no patient required emergency coronary artery bypass surgery in either g roup. There were three (7.1%, p = NS) stent thromboses and two (4.8%, p = NS) Q-wave myocardial infarctions in the warfarin group as compare d to none in the antiplatelet group. There was a significantly higher incidence of vascular complications in the warfarin group (21.4% vs. 0 %, p = 0.004). The length of hospital stay was significantly shorter i n the antiplatelet group (3.4 (2.0) vs. 7.8 (2.6) days, p < 0.001). Th is study suggests that reduced anticoagulation with antiplatelet thera py alone after ''bail-out'' stenting is an effective and safe strategy which reduces vascular complications and hospital stay without increa sing the rate of stent thrombosis.