Antithrombotic treatment after coronary artery stenting in patients on chronic oral anticoagulation: an international survey of current clinical practice

Abstract

Background: In the absence of evidence-based data, the optimal antithrombotic treatment after coronary artery stenting in patients on chronic oral anticoagulation (OAC) remains unknown. In order to investigate current practice in this setting, an international survey was carried out.

Methods: A questionnaire was e-mailed to 40 internationally renowned, foreign Interventional Centers worldwide.

Results: Out of the 24 Centers (60%) replying, only in 13 (54%) is antithrombotic treatment carried out in accordance with a standardized protocol. OAC is stopped in favor of aspirin plus ticlopidine/clopidogrel in selected (low thromboembolic risk) conditions in 13 (54%) Centers. When OAC is continued, the association with a single antiplatelet is employed in a few Centers only, as opposed to triple antithrombotic treatment (OAC and aspirin plus ticlopidine/clopidogrel) which is adopted, selectively or systematically, in the majority (83%) of Centers. In 8 (33%) Centers adopting triple antithrombotic treatment, the dose of OAC is decreased in all patients, whereas in 9 (38%) it is left unchanged. Upon completion of 1 to 3-6 months of antithrombotic treatment with OAC and single/dual antiplatelets, in 9 (38%) Centers this regimen is continued indefinitely, whereas in 10 (41%) antiplatelets are systematically withdrawn. Out of the 13 Centers, selectively exchanging OAC for aspirin plus ticlopidine/clopidogrel, low- or full-dose low-molecular-weight heparin is added in selected (high thromboembolic risk) cases in 3 (23%) and 5 (38%) Centers, respectively. Following 1 to 3-6 months of aspirin plus ticlopidine/clopidogrel antithrombotic treatment, OAC is resumed in all cases in 9 (69%) Centers and in no cases in 1 (8%).

Conclusions: Our survey shows a high variability in the current antithrombotic treatment of patients on chronic OAC undergoing coronary artery stenting. Although various regimens may be adopted, the optimal antithrombotic treatment for this patient subset still needs to be identified.