Two-pronged antiplatelet therapy with aspirin and ticlopidine without systemic anticoagulation: an alternative therapeutic strategy after bailout stent implantation.

BACKGROUND

Intracoronary stent implantation for failed angioplasty is associated with a relatively high incidence of coronary and peripheral complications. On the basis of previous clinical and experimental data, we investigated a protocol of intensive antiplatelet therapy, with aspirin (200 mg) and ticlopidine (500 mg), without oral anticoagulation, and with only periprocedural heparin, after stent implantation.

METHODS

Between November 1993 and May 1994, 650 patients underwent balloon angioplasty in our institution. Stent implantation was attempted in 45 patients because of acute (58%) or threatened acute (22%) closure, or because the result of the primary angioplasty was inadequate (9%).

RESULTS

Stents were successfully implanted in 42 (93%) patients. Two patients were not enrolled in the protocol (referring physician preference in one, metallic heart valve prosthesis in the other). In the remaining 40 patients, two sustained Q-wave infarctions and three sustained non Q-wave infarctions, which were already established at the time of stent implantation. No further clinical events occurred during hospitalization. During follow-up (mean 3.2 months) none of the patients died and none developed unstable angina or myocardial infarction. Ticlopidine-related rash occurred in two patients who were consequently put on warfarin therapy instead.

CONCLUSIONS

Antiplatelet therapy with ticlopidine and aspirin, without systemic anticoagulation, appears to be a promising alternative to the classical approach with heparin and warfarin therapy, which requires intensive biological monitoring. This approach considerably simplifies patient management, and it could reduce the need for prolonged hospitalization.