Long-term safety of drug-eluting stents in patients on warfarin treatment

Abstract

Selective use of DES with a short triple therapy seems to be safe in patients with warfarin therapy. The prognosis of this fragile patient population is quite poor, and major bleeding events are common irrespective of stent type.

Bare-Metal vs. Drug-Eluting Stents in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

“…Our results are supported by a propensity score-matched study in which DES implantation was not associated with increased major bleeding or ischemic/ thrombotic complications. 30 The same study reported that ST was rare after cessation of a short course of triple therapy, suggesting that "brief" triple therapy following DES implantation in this patient subset may be sufficient to prevent ST, while reducing bleeding complications. 30 In a pooled analysis, the incidence of major bleeding increased from 4.6% to 10.3% when the duration of triple therapy increased from 1 month to 6-12 months or more.…”

“…30 The same study reported that ST was rare after cessation of a short course of triple therapy, suggesting that "brief" triple therapy following DES implantation in this patient subset may be sufficient to prevent ST, while reducing bleeding complications. 30 In a pooled analysis, the incidence of major bleeding increased from 4.6% to 10.3% when the duration of triple therapy increased from 1 month to 6-12 months or more. 1 This underscores the importance of the duration of triple therapy, which should be minimal based on careful evaluation of the individual patient's risk of ischemic and bleeding complications.…”

Pancreatic cancer control

“…Some studies reported a reduction in target vessel revascularization rates with an increased risk of bleeding with the use of DES in this population, whereas others found no differences in bleeding events [5,6]. Some studies reported a reduction in target vessel revascularization rates with an increased risk of bleeding with the use of DES in this population, whereas others found no differences in bleeding events [5,6].…”

“…However, a percutaneous coronary intervention with stent implantation (PCI-S) requires dual-antiplatelet therapy (DAPT), commonly consisting of aspirin and a P2Y12 antagonist [2]. Some studies reported a reduction in target vessel revascularization rates with an increased risk of bleeding with the use of DES in this population, whereas others found no differences in bleeding events [5,6]. For these patients, guidelines recommend combining OAC with antiplatelet therapy, so-called triple therapy (TT), despite the increased risk of bleeding [2].…”

Dual or triple therapy in patients with atrial fibrillation and drug-eluting stents?

“…Some studies reported a reduction in target vessel revascularization rates with an increased risk of bleeding with the use of DES in this population, whereas others found no differences in bleeding events [5,6]. The lack of randomized clinical trials and the small sample size of available studies have led to the recommendation of restricting the use of DES in patients with OAC indication.…”