A Randomized Comparison of Combined Ticlopidine and Aspirin Therapy Versus Aspirin Therapy Alone After Successful Intravascular Ultrasound–Guided Stent Implantation

Hall, Patrick; Nakamura, Shigeru; Maiello, Luigi; Itoh, Akira; Blengino, Simonetta; Martini, G.; Ferraro, Massimo; Colombo, Antonio

doi:10.1161/01.cir.93.2.215

Cited by 256 publications

(110 citation statements)

References 27 publications

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“…Indeed, the vast majority of studies of antiplatelet therapy after stent implantation, including the only other randomized study to date, have specifically excluded this patient population. 4,9,11,12 The present study shows that acute stent occlusion may also occur in the absence of mechanical predisposing factors such as residual dissection. Indeed, in 2 of the 6 cases of acute occlusion in the antiplatelet group, the procedure was uncomplicated and the angiographic result optimal.…”

Section: Discussionmentioning

confidence: 50%

Randomized Multicenter Comparison of Conventional Anticoagulation Versus Antiplatelet Therapy in Unplanned and Elective Coronary Stenting

Bertrand¹,

Legrand²,

Boland³

et al. 1998

Circulation

529

217

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Background —Dual therapy with ticlopidine and aspirin has been shown to be as effective as or more effective than conventional anticoagulation in patients with an optimal result after implantation of intracoronary metallic stents. However, the safety and efficacy of antiplatelet therapy alone in an unselected population has not been evaluated. Methods —Patients were randomized to conventional anticoagulation or to treatment with antiplatelet therapy alone. Indications for stenting were classified as elective (decided before the procedure) or unplanned (to salvage failed angioplasty or to optimize the results of balloon angioplasty). After stenting, patients received aspirin and either ticlopidine or conventional anticoagulation (heparin or oral anticoagulant). The primary end point was the occurrence of bleeding or peripheral vascular complications; secondary end points were cardiac events (death, infarction, or stent occlusion) and duration of hospitalization. Results —In 13 centers, 236 patients were randomized to anticoagulation and 249 to antiplatelet therapy. Stenting was elective in 58% of patients and unplanned in 42%. Stent implantation was successfully achieved in 99% of patients. A primary end point occurred in 33 patients (13.5%) in the antiplatelet group and 48 patients (21%) in the anticoagulation group (odds ratio=0.6 [95% CI 0.36 to 0.98], P =0.03). Major cardiac-related events in electively stented patients were less common (odds ratio=0.23 [95% CI 0.05 to 0.91], P =0.01) in the antiplatelet group (3 of 123, 2.4%) than the anticoagulation group (11 of 111, 9.9%). Hospital stay was significantly shorter in the antiplatelet group (4.3±3.6 versus 6.4±3.7 days, P =0.0001). Conclusions —Antiplatelet therapy after coronary stenting significantly reduced rates of bleeding and subacute stent occlusion compared with conventional anticoagulation.

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Section: Discussionmentioning

confidence: 50%

Randomized Multicenter Comparison of Conventional Anticoagulation Versus Antiplatelet Therapy in Unplanned and Elective Coronary Stenting

Bertrand¹,

Legrand²,

Boland³

et al. 1998

Circulation

529

217

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“…Clinical and angiographic demographics of patients with unplanned stent deployment are not well described. In addition, although adjunct antiplatelet therapy with ticlopidine and aspirin appears superior to systemic anticoagulation after planned stent deployment, [1][2][3] the adequacy of such therapy in patients with an unplanned stent is not defined. Lastly, the potential for platelet GP IIb/IIIa blockade to improve clinical outcomes in patients with unplanned coronary stent deployment has not been prospectively evaluated in a placebocontrolled, randomized trial.…”

mentioning

confidence: 99%

Abciximab Therapy and Unplanned Coronary Stent Deployment

Kereiakes

Lincoff²,

Miller³

et al. 1998

Circulation

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Background-The clinical and angiographic demographics of patients requiring unplanned coronary stent deployment and the optimal adjunct pharmacotherapy in this population are not well described. This report details the EPILOG trial experience with unplanned coronary stent deployment and the effect of abciximab platelet glycoprotein IIb/IIIa blockade to improve clinical outcomes during 6 months of follow-up. Methods and Results-After randomization in the EPILOG double-blind, placebo-controlled trial of abciximab therapy during percutaneous coronary intervention, 326 (12%) of 2792 patients required unplanned coronary stent deployment. Although stented patients were not distinguished by clinical variables, they had greater coronary lesion complexity by American Heart Association/American College of Cardiology criteria (Pϭ.003) and greater incidence of lesion length Ͼ10 mm (Pϭ.002), lesion eccentricity (Pϭ.027), irregular lesion contour (Pϭ.001), and bifurcation involvement (Pϭ.019) than nonstented patients. Unplanned stents were required less often in patients treated with abciximab and low-dose, weight-adjusted heparin than in patients receiving placebo and standard-dose heparin (9.0% versus 13.7%; Pϭ.001). Although adverse clinical outcomes including target-vessel revascularization and bleeding events were more frequent in patients requiring unplanned coronary stent deployment, abciximab therapy reduced adverse outcomes in these patients at 30 days and 6 months to a greater extent than was observed in patients not requiring stent placement. Among stented patients, abciximab therapy did not increase bleeding events. Conclusions-Patients requiring unplanned coronary stent deployment have more complex coronary lesion morphology and a more complicated clinical course after coronary intervention. Abciximab therapy both reduces the need for unplanned stent deployment and confers clinical benefit to patients requiring an unplanned stent, without increasing bleeding complications. (Circulation. 1998;97:857-864.)

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“…Since the pioneering works in the nineties, the dual antiplatelet treatment has been considered the cornerstone in the prevention of stent thrombosis [12][13][14]. Despite the accessibility of this treatment, there is still a cohort of patients with major cardiovascular events after successful treatment, and these events seem to be associated with low antiplatelet effect of clopidogrel [7,15,16].…”

Section: Discussionmentioning

confidence: 99%

High-residual platelet activity despite dual antiplatelet treatment associated with subacute stent thrombosis

et al. 2009

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AbstractHigh-residual platelet activity despite the dual antiplatelet treatment with aspirin and clopidogrel is associated with major adverse cardiac events, including stent thrombosis. Acute and subacute stent thrombosis is rare, but presents itself with serious complications including high mortality and morbidity rates. Light transmittance aggregometry with specific agonists — arachidonic acid and 5-adenosin diphosphate — is still considered a standard for the assessment of platelet reactivity, besides novel methods like vasodilator-stimulated phosphoprotein phosphorylation. In our case study, we report the coincidence of high-residual platelet activity with subacute stent thrombosis despite the recommended doses of antiplatelet agents — aspirin and clopidogrel. Stent thrombosis was treated by aspiration thrombectomy, and antiplatelet treatment was modified by increasing the dose of aspirin and substituting clopidogrel with a firstgeneration thienopyridin — ticlopidin. The effect of the treatment was documented by reaching the optimal inhibition of platelet reactivity. In the 6- and 12-month follow-up, the patient presented no ischemic events.

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A Randomized Comparison of Combined Ticlopidine and Aspirin Therapy Versus Aspirin Therapy Alone After Successful Intravascular Ultrasound–Guided Stent Implantation

Cited by 256 publications

References 27 publications

Randomized Multicenter Comparison of Conventional Anticoagulation Versus Antiplatelet Therapy in Unplanned and Elective Coronary Stenting

Randomized Multicenter Comparison of Conventional Anticoagulation Versus Antiplatelet Therapy in Unplanned and Elective Coronary Stenting

Abciximab Therapy and Unplanned Coronary Stent Deployment

High-residual platelet activity despite dual antiplatelet treatment associated with subacute stent thrombosis

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