TY - JOUR
T1 - Safety of drug-eluting stents compared to bare metal stents in patients with an indication for long-term oral anticoagulation
T2 - A propensity score matched analysis
AU - Limeres, Javier
AU - Lip, Gregory Y H
AU - Del Blanco, Bruno García
AU - Ferreira-González, Ignacio
AU - Mutuberria, Maria
AU - Alfonso, Fernando
AU - Bueno, Héctor
AU - Cequier, Angel
AU - Prendergast, Bernard
AU - Zueco, Javier
AU - Rodríguez-Leor, Oriol
AU - Barrabés, José A
AU - García-Dorado, David
AU - Sambola, Antonia
PY - 2019/5
Y1 - 2019/5
N2 - Background: Drug-eluting stents (DES) reduce stent restenosis compared with bare-metal stents (BMS). However, their use in patients requiring long-term oral anticoagulation (OAC) is controversial owing to increased risk of bleeding associated with OAC plus antiplatelet treatment over time. Objective: To assess the safety of DES vs BMS in patients requiring long-term OAC for any reason. Methods: Prospective observational multicenter study conducted at 6 teaching centers of patients undergoing percutaneous coronary intervention who required OAC for any reason. Adverse outcomes were analyzed at 1 year of follow-up. Results: We identified 1002 patients requiring OAC (mean age: 72 years, male 72%). Six- hundred and thirteen patients (61.2%) received BMS and 389 (38.8%) DES. Diabetes, previous PCI, myocardial infarction and acute coronary syndrome at admission (P < 0.0001) were more common in patients with DES. Antithrombotic prescribing was similar at discharge between groups (TT: 51.5% vs 50.9%, clopidogrel plus OAC: 7.0% vs 5.0% and DAPT: 41.4% vs 42.7%, p = 0.52). DES and BMS patients showed similar rates of total bleeding (15.2% vs 13.4%, adjusted HR 0.82 [0.58–1.17, p = 0.82 and major bleeding (6.2% vs 6.0%; adjusted HR 1.22 [0.71–2.09], p = 0.46) and MACE (15.2% vs 18.6%, adjusted HR: 0.82 [0.57–1.17], p = 0.28, while restenosis was lower in patients with DES (5.3% vs 8.5%, adjusted HR. (0.52 [0.29–0.92], p = 0.02. Cox analysis after propensity score selection of 368 matched pairs demonstrated that DES use was not associated with a higher incidence of total bleeding or major bleeding. Conclusion: DES use is safe in patients with an indication for long-term OAC.
AB - Background: Drug-eluting stents (DES) reduce stent restenosis compared with bare-metal stents (BMS). However, their use in patients requiring long-term oral anticoagulation (OAC) is controversial owing to increased risk of bleeding associated with OAC plus antiplatelet treatment over time. Objective: To assess the safety of DES vs BMS in patients requiring long-term OAC for any reason. Methods: Prospective observational multicenter study conducted at 6 teaching centers of patients undergoing percutaneous coronary intervention who required OAC for any reason. Adverse outcomes were analyzed at 1 year of follow-up. Results: We identified 1002 patients requiring OAC (mean age: 72 years, male 72%). Six- hundred and thirteen patients (61.2%) received BMS and 389 (38.8%) DES. Diabetes, previous PCI, myocardial infarction and acute coronary syndrome at admission (P < 0.0001) were more common in patients with DES. Antithrombotic prescribing was similar at discharge between groups (TT: 51.5% vs 50.9%, clopidogrel plus OAC: 7.0% vs 5.0% and DAPT: 41.4% vs 42.7%, p = 0.52). DES and BMS patients showed similar rates of total bleeding (15.2% vs 13.4%, adjusted HR 0.82 [0.58–1.17, p = 0.82 and major bleeding (6.2% vs 6.0%; adjusted HR 1.22 [0.71–2.09], p = 0.46) and MACE (15.2% vs 18.6%, adjusted HR: 0.82 [0.57–1.17], p = 0.28, while restenosis was lower in patients with DES (5.3% vs 8.5%, adjusted HR. (0.52 [0.29–0.92], p = 0.02. Cox analysis after propensity score selection of 368 matched pairs demonstrated that DES use was not associated with a higher incidence of total bleeding or major bleeding. Conclusion: DES use is safe in patients with an indication for long-term OAC.
KW - Anticoagulants
KW - Bleeding
KW - Drug-eluting stents
KW - Triple therapy
UR - http://www.scopus.com/inward/record.url?scp=85063351382&partnerID=8YFLogxK
U2 - 10.1016/j.thromres.2019.02.021
DO - 10.1016/j.thromres.2019.02.021
M3 - Journal article
C2 - 30925398
SN - 0049-3848
VL - 177
SP - 180
EP - 186
JO - Thrombosis Research
JF - Thrombosis Research
ER -