Adequate time in therapeutic INR range using triple antithrombotic therapy is not associated with long-term cardiovascular events and major bleeding complications after drug-eluting stent implantation. Issue 6 (December 2016)

• Record Type: Journal Article
• Authors: Konishi, Hirokazu; Miyauchi, Katsumi; Kasai, Takatoshi; Tsuboi, Shuta; Ogita, Manabu; Naito, Ryo; Dohi, Tomotaka; Tamura, Hiroshi; Okazaki, Shinya; Daida, Hiroyuki
• Is Part Of: Journal of cardiology. Volume 68:Issue 6(2016:Dec.)
• Page Start: 517
• Page End: 522
• Publication Date: 2016-12
• Subjects: Triple antithrombotic therapy -- International normalized ratio of prothrombin time -- Time in the therapeutic range -- Bleeding complication; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2015.10.019
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: Triple antithrombotic therapy increases the risk of bleeding events in patients undergoing percutaneous coronary intervention (PCI) compared with dual anti-platelet therapy (DAPT). However, whether warfarin control is associated with reduced cardiovascular events and major bleeding events in patients undergoing PCI with triple antithrombotic therapy is uncertain. Methods: We investigated 1207 consecutive patients who underwent PCI between 2004 and 2011. Major bleeding complications and major adverse cardiac and cerebrovascular events (MACCE) defined as all-cause death, acute coronary syndrome, target vessel revascularization, and stroke were compared between groups of patients who received either triple antithrombotic therapy or DAPT. Results: Triple antithrombotic therapy was administered to 95 (7.9%) patients. The mean international normalized ratio of prothrombin time (PT-INR) was 1.8. The target PT-INR level was set between 1.6 and 2.6 and the ratio (%) of time in the therapeutic range (TTR) was calculated. The median TTR was 78.4% (interquartile range, 67.4–87.6%). Kaplan–Meier survival curves showed that warfarin therapy was not associated with MACCE ( p = 0.89) and major bleeding ( p = 0.80). Multivariable Cox regression analysis revealed that triple antithrombotic therapy was not an independent predictor of MACCE and major bleeding. Conclusions: Triple antithrombotic therapy does not increase the occurrence of MACCE and major bleeding complications, if the warfarin dose is tightly controlled with a lower INR.