Monday, March 16, 2009
hart aspirine clopidogrel
This study shows that warfarin, aspirin and clopidogrel therapy following coronary stenting results in a significantly increased bleeding risk compared with dual antiplatelet therapy. Whether any modification of this traditional triple therapy would result in similar efficacy, but improved safety, needs further studies.
Previous studies of anticoagulation and concomitant antiplatelet therapy. Orford et al.[7] performed a retrospective study of 65 patients requiring triple therapy. They found a 9.2% incidence of bleeding events, with 3.1% major bleeding episodes. Treatment consisted mainly of stopping either warfarin or antiplatelet therapy. Rubboli et al.[8] performed an international survey of the various antithrombotic regimens following stent implantation in patients requiring chronic anticoagulation therapy. They found a wide spectrum of different regimens ranging from the triple therapy to dual antiplatelet therapy to any permutations in-between, including the addition of one antiplatelet agent to coumadin or replacement of warfarin with low-molecular weight heparin. This study did not report on clinical consequences, such as the bleeding or stent thrombosis rates. The randomized trials to evaluate the optimal post-stent regimen[1-4] consistently reported that the dual antiplatelet therapy resulted in reduced stent thrombosis and adverse cardiac events, as well as reduced bleeding risk compared with warfarin and aspirin therapy. Studies of anticoagulation and concomitant antiplatelet therapy in patients with prosthetic heart valves[9] suggest that antiplatelet therapy does increase the bleeding risk, with a lower dosage of aspirin resulting in less bleeding while providing benefit regarding systemic embolism or mortality. Buresly et al.[10] studied elderly (> 65 years) Canadian patients, who were admitted to Québec hospitals with acute myocardial infarction and whose prescription medications, including aspirin, warfarin and either ticlopidine or clopidogrel, were available from another database. They found the overall risk of bleeding to be 'small' in this population, although the addition of warfarin or thienopyridine to aspirin significantly increased the bleeding risk compared with aspirin alone.
Previous studies of anticoagulation and concomitant antiplatelet therapy. Orford et al.[7] performed a retrospective study of 65 patients requiring triple therapy. They found a 9.2% incidence of bleeding events, with 3.1% major bleeding episodes. Treatment consisted mainly of stopping either warfarin or antiplatelet therapy. Rubboli et al.[8] performed an international survey of the various antithrombotic regimens following stent implantation in patients requiring chronic anticoagulation therapy. They found a wide spectrum of different regimens ranging from the triple therapy to dual antiplatelet therapy to any permutations in-between, including the addition of one antiplatelet agent to coumadin or replacement of warfarin with low-molecular weight heparin. This study did not report on clinical consequences, such as the bleeding or stent thrombosis rates. The randomized trials to evaluate the optimal post-stent regimen[1-4] consistently reported that the dual antiplatelet therapy resulted in reduced stent thrombosis and adverse cardiac events, as well as reduced bleeding risk compared with warfarin and aspirin therapy. Studies of anticoagulation and concomitant antiplatelet therapy in patients with prosthetic heart valves[9] suggest that antiplatelet therapy does increase the bleeding risk, with a lower dosage of aspirin resulting in less bleeding while providing benefit regarding systemic embolism or mortality. Buresly et al.[10] studied elderly (> 65 years) Canadian patients, who were admitted to Québec hospitals with acute myocardial infarction and whose prescription medications, including aspirin, warfarin and either ticlopidine or clopidogrel, were available from another database. They found the overall risk of bleeding to be 'small' in this population, although the addition of warfarin or thienopyridine to aspirin significantly increased the bleeding risk compared with aspirin alone.
# posted by roodbont @ 11:35 AM 
