NEW YORK (Reuters Health) – Adding dual antiplatelet therapy on top of existing anticoagulant therapy increases the bleeding risk after percutaneous coronary stenting, according to results from the Stenting and Oral Anticoagulation (STENTICO) registry.

Dr. Martine Gilard from University Hospital of Brest, France, and the STENTICO investigators point out that there’s substantial variation among anti-thrombosis protocols for patients on long-term oral anticoagulant therapy who undergo coronary stenting, and none of the expert bodies has recommendations for such circumstances.

Using data from STENTICO – “the first prospective multicenter registry” of stenting and oral anticoagulation – the researchers analyzed the safety and efficacy of dual antiplatelet therapy after coronary stenting in association with oral anticoagulant therapy in 359 patients. Their findings appear in the August 1 issue of the American Journal of Cardiology.

The incidence of moderate and severe bleeding was significantly higher among patients who received oral anticoagulants and dual antiplatelet therapy (6.4%) than among patients who discontinued their oral anticoagulant therapy (2.1%), the authors report.

Bleeding risk was significantly higher among patients treated with a femoral approach (10.3%) than among those treated with a radial approach (3.8%).

There were no differences in rates of stroke or stent thrombosis between patients who continued oral anticoagulants and those who discontinued them.

“The results from this first prospective multicenter registry have confirmed that adding dual antiplatelet therapy to pre-existing oral anticoagulant therapy increases the peri- and post-percutaneous coronary intervention bleeding risk,” the investigators conclude.

“Temporary discontinuation decreased this bleeding risk but tended to increase the risk of stroke,” they add.

Reference:
Am J Cardiol 2009;104:338-342.