nach oben

Journal of Cardiovascular Translational Research

Erschienen in:

01.02.2014

Optimizing Antithrombotic Therapy After Coronary Stent Implantation in Patients on Chronic Oral Anticoagulation

verfasst von: N. Bennaghmouch, D. Sprenkeler, K. Qaderdan, J. M. ten Berg

Erschienen in: Journal of Cardiovascular Translational Research | Ausgabe 1/2014

Einloggen, um Zugang zu erhalten

Abstract

Most patients on chronic oral anticoagulation have a lifelong indication. When these patients undergo percutaneous coronary interventions with stent implantation, they also have an indication for dual antiplatelet therapy (aspirin and a P2Y12 inhibitor). However, this so-called triple therapy results in increased bleeding risks which in turn is associated with increased mortality. Furthermore, emerging stronger antiplatelet drugs (prasugrel and ticagrelor) are associated with increased bleeding, making triple therapy even more hazardous. This created a clinical treatment dilemma for this subset of patients, and new trials have been designed to explore new treatment strategies. This review summarizes the available evidence regarding the optimal treatment of patients on chronic oral anticoagulation undergoing percutaneous coronary interventions with stent implantation.

Nur mit Berechtigung zugänglich

Schömig, A., Neumann, F. J., Kastrati, A., et al. (1996). A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. The New England Journal of Medicine, 334, 1084–1089.PubMedCrossRef

Grines, C. L., Bonow, R. O., Casey, D. E., Jr., et al. (2007). Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation, 115, 813–818.PubMedCrossRef

Hamm, C. W., Bassand, J. P., Agewall, S., et al. (2011). ESC committee for practice guidelines. ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 32(23), 2999–3054.PubMedCrossRef

Schlitt, A., von Bardeleben, R. S., Ehrlich, A., et al. (2003). Clopidogrel and aspirin in the prevention of thromboembolic complications after mechanical aortic valve replacement (CAPTA). Thrombosis Research, 109(2–3), 131–135.PubMedCrossRef

Karjalainen, P. P., Porela, P., Ylitalo, A., et al. (2007). Safety and efficacy of combined antiplatelet-warfarin therapy after coronary stenting. European Heart Journal, 28, 726–732.PubMedCrossRef

Hart, R. G., Benavente, O., McBride, R., et al. (1999). Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Annals of Internal Medicine, 131, 492–501.PubMedCrossRef

Lip, G. Y., Huber, K., Andreotti, F., et al. (2010). European Society of Cardiology Working Group on Thrombosis. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Thrombosis and Haemostasis, 103, 13–28.PubMedCrossRef

Connolly, S., Pogue, J., Hart, R., et al. (2006). ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE W): a randomised controlled trial. Lancet, 367, 1903–1912.PubMedCrossRef

Van Walraven, C., Hart, R. G., Singer, D. E., et al. (2002). Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. JAMA, 288(19), 2441–2448.PubMedCrossRef

10.

Aguilar, M. I., Hart, R., & Pearce, L. A. (2007). Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no history of stroke or transient ischemic attacks. Cochrane Database of Systematic Reviews, 3, CD006186.PubMed

11.

Rubboli, A., Halperin, J. L., Airaksinen, K. E., et al. (2008). Antithrombotic therapy in patients treated with oral anticoagulation undergoing coronary artery stenting. An expert consensus document with focus on atrial fibrillation. Annals of Medicine, 40, 428–436.PubMedCrossRef

12.

13.

Camm, A. J., Kirchhof, P., & Lip, G. Y. (2010). European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). European Heart Journal, 31, 1360–1420.

14.

Faxon, D. P., Eikelboom, J. W., Berger, P. B., et al. (2011). Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North-American perspective. Thrombosis and Haemostasis, 106, 572–584.PubMedCrossRef

15.

Lamberts, M., Olesen, J. B., Ruwald, M. H., et al. (2012). Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention: a nationwide cohort study. Circulation, 126, 1185–1193.PubMedCrossRef

16.

Krasner, A., & Halperin, J. L. (2013). Antithrombotic therapy for patients with nonvalvular atrial fibrillation undergoing percutaneous coronary intervention: a review. Current Cardiology Reports, 15(378), 013–0378-y.

17.

Gao, F., Zhou, Y. J., Wang, Z. J., et al. (2011). Meta-analysis of the combination of warfarin and dual antiplatelet therapy after coronary stenting in patients with indications for chronic oral anticoagulation. International Journal of Cardiology, 148, 96–101.PubMedCrossRef

18.

Zhao, H. J., Zheng, Z. T., Wang, Z. H., et al. (2011). “Triple therapy” rather than “triple threat”: a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest, 139, 260–270.PubMedCrossRef

19.

Singh, P. P., Singh, M., Bedi, U., et al. (2011). Safety and efficacy of triple antithrombotic therapy after percutaneous coronary intervention in patients needing long-term anticoagulation. Therapeutic Advances in Cardiovascular Disease, 5, 23–31.PubMedCrossRef

20.

Andrade, J. G., Deyell, M. W., Khoo, C., et al. (2013). Risk of bleeding on triple antithrombotic therapy after percutaneous coronary intervention/stenting: a systematic review and meta-analysis. The Canadian Journal of Cardiology, 29, 204–212.PubMedCrossRef

21.

Saheb, K. J., Deng, B. Q., Hu, Q. S., et al. (2013). Triple antithrombotic therapy versus double antiplatelet therapy after percutaneous coronary intervention with stent implantation in patients requiring chronic oral anticoagulation: a meta-analysis. Chinese Medical Journal, 126, 2536–2542.PubMed

22.

Hansen, M. L., Sørensen, R., Clausen, M. T., et al. (2010). Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Archives of Internal Medicine, 170(16), 1433–1441.PubMedCrossRef

23.

Smith, J. G., Wieloch, M., Koul, S., et al. (2012). Triple antithrombotic therapy following an acute coronary syndrome: prevalence, outcomes and prognostic utility of the HAS-BLED score. EuroIntervention, 8(6), 672–678.PubMedCrossRef

24.

25.

Wallentin, L., Becker, R. C., Budaj, A., et al. (2009). PLATO Investigators, Freij A, Thorsén M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 361(11), 1045–57.PubMedCrossRef

26.

Montalescot, G., Wiviott, S. D., Braunwald, E., et al. (2009). TRITON-TIMI 38 investigators. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet, 373(9665), 723–731.PubMedCrossRef

27.

Wiviott, S. D., Braunwald, E., McCabe, C. H., et al. (2007). TRITON-TIMI 38 investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. New England Journal of Medicine, 357(20), 2001–2015.PubMedCrossRef

28.

Sarafoff, N., Martischnig, A., Wealer, J., et al. (2013). Triple therapy with aspirin, prasugrel, and vitamin K antagonists in patients with drug-eluting stent implantation and an indication for oral anticoagulation. Journal of the American College of Cardiology, 61(20), 2060–2066.PubMedCrossRef

29.

Wallentin, L., Wilcox, R. G., Weaver, W. D., et al. (2003). Oral ximelagatran for secondary prophylaxis after myocardial infarction: the ESTEEM randomised controlled trial. Lancet, 362, 789–797.PubMedCrossRef

30.

Alexander, J. H., Becker, R. C., Bhatt, D. L., et al. (2009). Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) trial. Circulation, 119, 2877–2885.PubMedCrossRef

31.

Mega, J. L., Braunwald, E., Mohanavelu, S., et al. (2009). Rivaroxaban versus placebo in patients with acute coronary syndromes (ATLAS ACS-TIMI 46): a randomised, double-blind, phase II trial. Lancet, 374, 29–38.PubMedCrossRef

32.

Oldgren, J., Budaj, A., Granger, C. B., et al. (2011). Dabigatran vs. placebo in patients with acute coronary syndromes on dual antiplatelet therapy: a randomized, double-blind, phase II trial. European Heart Journal, 32, 2781–2789.PubMedCrossRef

33.

Steg, P. G., Mehta, S. R., Jukema, J. W., et al. (2011). RUBY-1: a randomized, double-blind, placebo-controlled trial of the safety and tolerability of the novel oral factor Xa inhibitor darexaban (YM150) following acute coronary syndrome. European Heart Journal, 32, 2541–2554.PubMedCrossRef

34.

Alexander, J. H., Lopes, R. D., Set, J., et al. (2011). Apixaban with antiplatelet therapy after acute coronary syndrome. The New England Journal of Medicine, 365, 699–708.PubMedCrossRef

35.

Mega, J. L., Braunwald, E., Wiviott, S. D., et al. (2012). Rivaroxaban in patients with a recent acute coronary syndrome. The New England Journal of Medicine, 366, 9–19.PubMedCrossRef

36.

Komocsi, A., Vorobcsuk, A., Kehl, D., et al. (2012). Use of new-generation oral anticoagulant agents in patients receiving antiplatelet therapy after an acute coronary syndrome: systematic review and meta-analysis of randomized controlled trials. Archives of Internal Medicine, 172(20), 1537–1545.PubMedCrossRef

37.

Oldgren, J., Wallentin, L., Alexander, J. H., et al. (2013). New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome: a systematic review and meta-analysis. European Heart Journal, 34(22), 1670–1680.PubMedCrossRef

38.

Dewilde, W. J., Oirbans, T., Verheugt, F. W., et al. (2013). WOEST study investigators. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet, 381(9872), 1107–1115.PubMedCrossRef

39.

Van Es, R. F., Jonker, J. J. C., Verheugt, F.W. A., for the Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis-2 (ASPECT-2) research group., et al. (2002). Aspirin and Coumadin after acute coronary syndromes (the ASPECT-2 study): a randomized controlled trial. Lancet, 360(9327), 109–113.

40.

Hurlen, M., Abdelnoor, M., Smith, P., et al. (2002). Warfarin, aspirin, or both after myocardial infarction. The New England Journal of Medicine, 347, 969–974.PubMedCrossRef

41.

Lamberts, M., Gislason, G. H., Olesen, J. B., et al. (2013). Oral anticoagulation and antiplatelets in atrial fibrillation patients after myocardial infarction and coronary intervention. Journal of the American College of Cardiology, 62(11), 981–989.PubMedCrossRef

42.

Seivani, Y., Abdel-Wahab, M., Geist, V., Richardt, et al. (2013). Long-term safety and efficacy of dual therapy with oral anticoagulation and clopidogrel in patients with atrial fibrillation treated with drug-eluting stents. Clinical Research in Cardiology, 102(11), 799–806.PubMedCrossRef

43.

Armstrong, E. J., Feldman, D. N., Wang, T. Y., et al. (2012). Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC: Cardiovascular Interventions, 5(2), 131–140.PubMed

44.

Kirtane, A. J. M. D. S. M., Gupta, A. M. D., Iyengar, S. M. D., et al. (2009). Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies. Circulation, 119(25), 3198–3206.PubMedCrossRef

45.

Daemen, J., Wenaweser, P., Tsuchida, K., et al. (2007). Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet, 369(9562), 667–678.PubMedCrossRef

46.

Mehta, S. R., Yusuf, S., Peters, R. J., et al. (2001). Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial (CURE) investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet, 358(9281), 527–533.PubMedCrossRef

47.

Steinhubl, S. R., Berger, P. B., Mann, J. T., III, et al. (2002). CREDO investigators: Clopidogrel for the reduction of events during observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA, 288(19), 2411–2420.PubMedCrossRef

48.

Iakovou, I., Schmidt, T., Bonizzoni, E., et al. (2005). Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA, 293(17), 2126–2130.PubMedCrossRef

49.

Eisenstein, E. L., Anstrom, K. J., Kong, D. F., et al. (2007). Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA, 297(2), 159–168.PubMedCrossRef

50.

Pfisterer, M., Brunner-La Rocca, H. P., Buser, P. T., et al. (2006). BASKET-LATE investigators. Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. Journal of the American College of Cardiology, 48(12), 2584–2591.PubMedCrossRef

51.

Cassese, S., Byrne, R. A., Tada, T., King, L. A., & Kastrati, A. (2012). Clinical impact of extended dual antiplatelet therapy after percutaneous coronary interventions in the drug-eluting stent era: a meta-analysis of randomized trials. European Heart Journal, 33(24), 3078–3087.PubMedCrossRef

52.

Feres F, Costa RA, Abizaid A, et al. Three vs twelve months of dual antiplatelet therapy after zotarolimus-eluting stents: the OPTIMIZE randomized trial. JAMA Oct 2013. [Epub ahead of print].

53.

Gwon, H. C., Hahn, J. Y., Park, K. W., et al. (2012). Six-month versus 12-month dual antiplatelet therapy after implantation of drug-eluting stents: the Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) randomized, multicenter study. Circulation, 125, 505.PubMedCrossRef

54.

Kim, B. K., Hong, M. K., Shin, D. H., et al. (2012). A new strategy for discontinuation of dual antiplatelet therapy: the RESET trial (REal Safety and Efficacy of 3-Month Dual Antiplatelet Therapy Following Endeavor Zotarolimus-eluting Stent Implantation). Journal of the American College of Cardiology, 60, 1340.PubMedCrossRef

55.

ClinicalTrials.gov. Anticoagulation in stent intervention (MUSICA-2). Available at: http://clinicaltrials.gov/show/NCT01141153 [Last access at 4-12-2013].

56.

ClinicalTrials.gov. A study exploring two strategies of rivaroxaban (JNJ39039039; BAY-59-7939) and one of oral vitamin k antagonist in patients with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI). Available at: http://clinicaltrials.gov/show/NCT01830543. [Last access at 4-12-2013].

57.

ClinicalTrials.gov. Triple therapy in patients on oral anticoagulation after drug eluting stent implantation (ISAR-TRIPLE). Available at: http://clinicaltrials.gov/show/NCT00776633. [Last access at 4-12-2013].

58.

ClinicalTrials.gov. Safety and Efficacy of Six Months Dual Antiplatelet Therapy After Drug-Eluting Stenting (ISAR-SAFE). Available at: http://clinicaltrials.gov/show/NCT00661206. [Last access at 4-12-2013].

59.

ClinicalTrials.gov. The dual antiplatelet therapy study (DAPT study). Available at: http://clinicaltrials.gov/show/NCT00977938. [Last access at 4-12-2013].

Titel: Optimizing Antithrombotic Therapy After Coronary Stent Implantation in Patients on Chronic Oral Anticoagulation
verfasst von: N. Bennaghmouch
D. Sprenkeler
K. Qaderdan
J. M. ten Berg
Publikationsdatum: 01.02.2014
Verlag: Springer US
Erschienen in: Journal of Cardiovascular Translational Research / Ausgabe 1/2014
Print ISSN: 1937-5387
Elektronische ISSN: 1937-5395
DOI: https://doi.org/10.1007/s12265-013-9536-2

Neu im Fachgebiet Kardiologie

Screening-Mammografie offenbart erhöhtes Herz-Kreislauf-Risiko

26.04.2024 Mammografie Nachrichten

Routinemäßige Mammografien helfen, Brustkrebs frühzeitig zu erkennen. Anhand der Röntgenuntersuchung lassen sich aber auch kardiovaskuläre Risikopatientinnen identifizieren. Als zuverlässiger Anhaltspunkt gilt die Verkalkung der Brustarterien.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Adipositas-Medikament auch gegen Schlafapnoe wirksam

24.04.2024 Adipositas Nachrichten

Der als Antidiabetikum sowie zum Gewichtsmanagement zugelassene Wirkstoff Tirzepatid hat in Studien bei adipösen Patienten auch schlafbezogene Atmungsstörungen deutlich reduziert, informiert der Hersteller in einer Vorab-Meldung zum Studienausgang.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2014

Impact of Aspirin Dosing on the Effects of P2Y12 Inhibition in Patients with Acute Coronary Syndromes

Non Optical Semi-Conductor Next Generation Sequencing of the Main Cardiac QT-Interval Duration Genes in Pooled DNA Samples

Bridging antiplatelet therapy in patients requiring cardiac and non-cardiac surgery: from bench to bedside

Antiplatelet Therapy: Targeting the TxA2 Pathway