Brugaletta S, Martin-Yuste V, Ferreira-González I, Cola C, Alvarez-Contreras L, Antonio MD, Garcia-Moll X, García-Picart J, Martí V, Balcells-Iranzo J, Sabaté M. Adequate antiplatelet regimen in patients on chronic anti-vitamin K treatment undergoing percutaneous coronary intervention. World J Cardiol 2011; 3(11): 367-373 [PMID: 22125672 DOI: 10.4330/wjc.v3.i11.367]
Corresponding Author of This Article
Manel Sabaté, MD, PhD, FESC, Thorax Institute, Department of Cardiology, Hospital Clinic, c/ Villarroel 170, 08036 Barcelona, Spain. masabate@clinic.ub.es
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Brief Article
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World J Cardiol. Nov 26, 2011; 3(11): 367-373 Published online Nov 26, 2011. doi: 10.4330/wjc.v3.i11.367
Adequate antiplatelet regimen in patients on chronic anti-vitamin K treatment undergoing percutaneous coronary intervention
Salvatore Brugaletta, Victoria Martin-Yuste, Ignacio Ferreira-González, Clarissa Cola, Luis Alvarez-Contreras, Marta De Antonio, Xavier Garcia-Moll, Joan García-Picart, Vicens Martí, Jordi Balcells-Iranzo, Manel Sabaté
Salvatore Brugaletta, Victoria Martin-Yuste, Luis Alvarez-Contreras, Manel Sabaté, Thorax Institute, Department of Cardiology, Hospital Clinic, 08036 Barcelona, Spain
Ignacio Ferreira-González, Epidemiology Unit, Department of Cardiology, Vall d’Hebron Hospital, Center of Epidemiology and Public Heath, 08010 Barcelona, Spain
Clarissa Cola, Marta De Antonio, Joan García-Picart, Vicens Martí, Jordi Balcells-Iranzo, Interventional Cardiology Unit, University Hospital of Saint Paul, 08010 Barcelona, Spain
Xavier Garcia-Moll, Department of Cardiology, University Hospital of Saint Paul, 08010 Barcelona, Spain
Author contributions: Brugaletta S and Martin-Yuste V designed the study and drafted the paper; Ferreira-González I and Cola C performed the statistical analysis; Alvarez-Contreras L, De Antonio M and Garcia-Moll X performed the clinical follow-up; García-Picart J, Martí V and Balcells-Iranzo J recruited the patients; Sabaté M designed the study, reviewed the draft and made an intellectual contribution to the manuscript.
Supported by An EAPCI grant in Interventional Cardiology (to Brugaletta S)
Correspondence to: Manel Sabaté, MD, PhD, FESC, Thorax Institute, Department of Cardiology, Hospital Clinic, c/ Villarroel 170, 08036 Barcelona, Spain. masabate@clinic.ub.es
Telephone: +34-93-2279305 Fax: +34-93-2279306
Received: September 20, 2010 Revised: September 11, 2011 Accepted: September 17, 2011 Published online: November 26, 2011
Abstract
AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on anti-vitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).
METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug eluting stent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was defined according to type of stent implanted and to its clinical indication.
RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02).
CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes.
