Journal of Thrombosis and Thrombolysis

, Volume 35, Issue 2, pp 178–184

Major bleeding in patients undergoing PCI and triple or dual antithrombotic therapy: a parallel-cohort study

  • G. Denas
  • S. Padayattil Jose
  • P. Gresele
  • N. Erba
  • S. Testa
  • V. De Micheli
  • R. Quintavalla
  • D. Poli
  • A. Bracco
  • T. Fierro
  • S. Iliceto
  • V. Pengo
Article

DOI: 10.1007/s11239-012-0790-y

Cite this article as:
Denas, G., Padayattil Jose, S., Gresele, P. et al. J Thromb Thrombolysis (2013) 35: 178. doi:10.1007/s11239-012-0790-y

Abstract

The combination of oral anticoagulants with dual antiplatelet therapy (DAT) in patients undergoing percutaneous coronary intervention with stent implantation (PCI-stenting) is subject to controversy due to the high risk of bleeding. In this multicenter retrospective parallel-group study, we compared the rate of adverse events in chronically anticoagulated patients who underwent PCI-stenting and were discharged on aspirin, clopidogrel and warfarin (triple antithrombotic therapy [TT] group) and were followed in Italian anticoagulation centers, with a parallel cohort of patients who underwent PCI-stenting and were discharged on DAT group. The primary endpoint was the incidence of major bleeding while the patients were in TT and DAT. A secondary endpoint was the occurrence of major ischemic adverse events (MACEs). The final cohort consisted of 229 TT patients and 231 DAT patients followed up for 6 and 7 months, respectively. There were 11 (4.8 %; 9.1 % patient/years) major bleeding events in the TT group (1 was fatal) as compared to 1 (0.4 %; 0.7 % patient/years) event in the DAT group (p = 0.003). Of the 28 (6.1 %) MACE recorded during the follow-up, 12 (5.2 %) occurred in the TT group and 16 (6.9 %) in the DAT group. In conclusion, despite close monitoring of anticoagulated patients in dedicated centers, the major bleeding incidence remains high among unselected patients undergoing PCI-stenting and treated with TT. Any efforts to minimize these events should be pursued.

Keywords

Triple antithrombotic therapy Major bleeding MACE Dual antiplatelet therapy Warfarin 

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • G. Denas
    • 1
  • S. Padayattil Jose
    • 1
  • P. Gresele
    • 2
  • N. Erba
    • 3
  • S. Testa
    • 4
  • V. De Micheli
    • 3
  • R. Quintavalla
    • 5
  • D. Poli
    • 6
  • A. Bracco
    • 1
  • T. Fierro
    • 2
  • S. Iliceto
    • 1
  • V. Pengo
    • 1
  1. 1.Cardiology ClinicThrombosis Center, University HospitalPaduaItaly
  2. 2.Thrombosis CenterUniversity HospitalPerugiaItaly
  3. 3.Thrombosis CenterDistrict HospitalMerateItaly
  4. 4.Thrombosis CenterDistrict HospitalCremonaItaly
  5. 5.Thrombosis CenterUniversity HospitalParmaItaly
  6. 6.Thrombosis CenterUniversity HospitalFlorenceItaly

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