Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation
Dual antiplatelet therapy with aspirin and clopidogrel has replaced aspirin and systemic anticoagulation with warfarin as the preferred antithrombotic therapy after percutaneous coronary intervention (PCI) with stent placement. However, a number of patients have indications for all 3 drugs. We sough...
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| Veröffentlicht in: | The American heart journal 2004-03, Vol.147 (3), p.463-467 |
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| creator | Orford, James L Fasseas, Panayotis Melby, Steven Burger, Kelli Steinhubl, Steven R Holmes, David R Berger, Peter B |
| description | Dual antiplatelet therapy with aspirin and clopidogrel has replaced aspirin and systemic anticoagulation with warfarin as the preferred antithrombotic therapy after percutaneous coronary intervention (PCI) with stent placement. However, a number of patients have indications for all 3 drugs. We sought to determine the frequency and type of hemorrhagic complications in patients who undergo systemic anticoagulation with warfarin while receiving aspirin and clopidogrel after a PCI with stent placement.
We performed a retrospective analysis of the Mayo Clinic PCI database and identified 66 consecutive patients who were discharged from hospital after PCI between January 2000 and August 2002 (inclusive) receiving a combination of dual antiplatelet therapy (aspirin and clopidogrel) and systemic anticoagulation (warfarin) to determine the incidence of bleeding and other clinical events during the treatment period.
Six patients (9.2%; 95% CI, 3.5–19.0) reported a bleeding event; 2 patients required a blood transfusion. No patient died or sustained a myocardial infarction or stent thrombosis.
The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement. |
| doi_str_mv | 10.1016/j.ahj.2003.06.004 |
| format | Article |
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We performed a retrospective analysis of the Mayo Clinic PCI database and identified 66 consecutive patients who were discharged from hospital after PCI between January 2000 and August 2002 (inclusive) receiving a combination of dual antiplatelet therapy (aspirin and clopidogrel) and systemic anticoagulation (warfarin) to determine the incidence of bleeding and other clinical events during the treatment period.
Six patients (9.2%; 95% CI, 3.5–19.0) reported a bleeding event; 2 patients required a blood transfusion. No patient died or sustained a myocardial infarction or stent thrombosis.
The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2003.06.004</identifier><identifier>PMID: 14999195</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Aged ; Aged, 80 and over ; Angina, Unstable - therapy ; Angioplasty, Balloon, Coronary ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Aspirin - adverse effects ; Aspirin - therapeutic use ; Biological and medical sciences ; Cardiology ; Cardiology. Vascular system ; Coronary Disease - drug therapy ; Coronary Disease - therapy ; Coronary heart disease ; Drug therapy ; Drug Therapy, Combination ; Female ; Heart ; Heart attacks ; Hemorrhage - chemically induced ; Hospitalization ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - therapy ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Retrospective Studies ; Stents ; Ticlopidine - adverse effects ; Ticlopidine - analogs & derivatives ; Ticlopidine - therapeutic use ; Warfarin - adverse effects ; Warfarin - therapeutic use</subject><ispartof>The American heart journal, 2004-03, Vol.147 (3), p.463-467</ispartof><rights>2004 Mosby, Inc.</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Elsevier Limited Mar 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-d2be04ec2fd79da1e688a665d7666aa2c389755aa9fa92ad85692cf9dc97e4d23</citedby><cites>FETCH-LOGICAL-c407t-d2be04ec2fd79da1e688a665d7666aa2c389755aa9fa92ad85692cf9dc97e4d23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002870303007312$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15582495$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14999195$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Orford, James L</creatorcontrib><creatorcontrib>Fasseas, Panayotis</creatorcontrib><creatorcontrib>Melby, Steven</creatorcontrib><creatorcontrib>Burger, Kelli</creatorcontrib><creatorcontrib>Steinhubl, Steven R</creatorcontrib><creatorcontrib>Holmes, David R</creatorcontrib><creatorcontrib>Berger, Peter B</creatorcontrib><title>Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Dual antiplatelet therapy with aspirin and clopidogrel has replaced aspirin and systemic anticoagulation with warfarin as the preferred antithrombotic therapy after percutaneous coronary intervention (PCI) with stent placement. However, a number of patients have indications for all 3 drugs. We sought to determine the frequency and type of hemorrhagic complications in patients who undergo systemic anticoagulation with warfarin while receiving aspirin and clopidogrel after a PCI with stent placement.
We performed a retrospective analysis of the Mayo Clinic PCI database and identified 66 consecutive patients who were discharged from hospital after PCI between January 2000 and August 2002 (inclusive) receiving a combination of dual antiplatelet therapy (aspirin and clopidogrel) and systemic anticoagulation (warfarin) to determine the incidence of bleeding and other clinical events during the treatment period.
Six patients (9.2%; 95% CI, 3.5–19.0) reported a bleeding event; 2 patients required a blood transfusion. No patient died or sustained a myocardial infarction or stent thrombosis.
The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angina, Unstable - therapy</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - therapeutic use</subject><subject>Aspirin - adverse effects</subject><subject>Aspirin - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Coronary Disease - drug therapy</subject><subject>Coronary Disease - therapy</subject><subject>Coronary heart disease</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hemorrhage - chemically induced</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - therapy</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Stents</subject><subject>Ticlopidine - adverse effects</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Ticlopidine - therapeutic use</subject><subject>Warfarin - adverse effects</subject><subject>Warfarin - therapeutic use</subject><issn>0002-8703</issn><issn>1097-6744</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kMuOFCEUQInROO3oB7gxJMbdVAkURRVxZSa-kklcqGtyBy4zVKqLEmgn_Q3-tPQjmZ0rLpdzHxxCXnPWcsbV-6mF-6kVjHUtUy1j8gnZcKaHRg1SPiUbxphoxoF1F-RFzlO9KjGq5-SCS6011_2G_P0BHsuewuIoeh8s2D2NnkJeQwrLFbVzXIOLdwnnqyP1AMlDfaLgCyZqY4oLpD3NBZdC1xksbg9RJVYooYaZPoRyX4trztUJJcSF-phqpgQb4W43H3MvyTMPc8ZX5_OS_Pr86ef11-bm-5dv1x9vGivZUBonbpFJtMK7QTvgqMYRlOrdoJQCELYb9dD3ANqDFuDGXmlhvXZWDyid6C7J21PfNcXfO8zFTHGXljrS8J5JqSTrhkrxE2VTzDmhN2sK2_pTw5k56DeTqfrNQb9hylT9tebNufPudovuseLsuwLvzgBkC7NPsNiQH7m-H4U8ch9OHFYPfwImk21VadGFhLYYF8N_1vgHSeylJg</recordid><startdate>20040301</startdate><enddate>20040301</enddate><creator>Orford, James L</creator><creator>Fasseas, Panayotis</creator><creator>Melby, Steven</creator><creator>Burger, Kelli</creator><creator>Steinhubl, Steven R</creator><creator>Holmes, David R</creator><creator>Berger, Peter B</creator><general>Mosby, Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope></search><sort><creationdate>20040301</creationdate><title>Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation</title><author>Orford, James L ; Fasseas, Panayotis ; Melby, Steven ; Burger, Kelli ; Steinhubl, Steven R ; Holmes, David R ; Berger, Peter B</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-d2be04ec2fd79da1e688a665d7666aa2c389755aa9fa92ad85692cf9dc97e4d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angina, Unstable - therapy</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulants - therapeutic use</topic><topic>Aspirin - adverse effects</topic><topic>Aspirin - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Coronary Disease - drug therapy</topic><topic>Coronary Disease - therapy</topic><topic>Coronary heart disease</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hemorrhage - chemically induced</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - therapy</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Stents</topic><topic>Ticlopidine - adverse effects</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Ticlopidine - therapeutic use</topic><topic>Warfarin - adverse effects</topic><topic>Warfarin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Orford, James L</creatorcontrib><creatorcontrib>Fasseas, Panayotis</creatorcontrib><creatorcontrib>Melby, Steven</creatorcontrib><creatorcontrib>Burger, Kelli</creatorcontrib><creatorcontrib>Steinhubl, Steven R</creatorcontrib><creatorcontrib>Holmes, David R</creatorcontrib><creatorcontrib>Berger, Peter B</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><jtitle>The American heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Orford, James L</au><au>Fasseas, Panayotis</au><au>Melby, Steven</au><au>Burger, Kelli</au><au>Steinhubl, Steven R</au><au>Holmes, David R</au><au>Berger, Peter B</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation</atitle><jtitle>The American heart journal</jtitle><addtitle>Am Heart J</addtitle><date>2004-03-01</date><risdate>2004</risdate><volume>147</volume><issue>3</issue><spage>463</spage><epage>467</epage><pages>463-467</pages><issn>0002-8703</issn><eissn>1097-6744</eissn><coden>AHJOA2</coden><abstract>Dual antiplatelet therapy with aspirin and clopidogrel has replaced aspirin and systemic anticoagulation with warfarin as the preferred antithrombotic therapy after percutaneous coronary intervention (PCI) with stent placement. However, a number of patients have indications for all 3 drugs. We sought to determine the frequency and type of hemorrhagic complications in patients who undergo systemic anticoagulation with warfarin while receiving aspirin and clopidogrel after a PCI with stent placement.
We performed a retrospective analysis of the Mayo Clinic PCI database and identified 66 consecutive patients who were discharged from hospital after PCI between January 2000 and August 2002 (inclusive) receiving a combination of dual antiplatelet therapy (aspirin and clopidogrel) and systemic anticoagulation (warfarin) to determine the incidence of bleeding and other clinical events during the treatment period.
Six patients (9.2%; 95% CI, 3.5–19.0) reported a bleeding event; 2 patients required a blood transfusion. No patient died or sustained a myocardial infarction or stent thrombosis.
The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>14999195</pmid><doi>10.1016/j.ahj.2003.06.004</doi><tpages>5</tpages></addata></record> |
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| ispartof | The American heart journal, 2004-03, Vol.147 (3), p.463-467 |
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| subjects | Aged Aged, 80 and over Angina, Unstable - therapy Angioplasty, Balloon, Coronary Anticoagulants - adverse effects Anticoagulants - therapeutic use Aspirin - adverse effects Aspirin - therapeutic use Biological and medical sciences Cardiology Cardiology. Vascular system Coronary Disease - drug therapy Coronary Disease - therapy Coronary heart disease Drug therapy Drug Therapy, Combination Female Heart Heart attacks Hemorrhage - chemically induced Hospitalization Humans Male Medical sciences Middle Aged Myocardial Infarction - therapy Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Retrospective Studies Stents Ticlopidine - adverse effects Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use Warfarin - adverse effects Warfarin - therapeutic use |
| title | Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation |
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