Reference : Drug eluting stent implantation in patients requiring concomitant vitamin K antagonis...
Scientific journals : Article
Human health sciences : Cardiovascular & respiratory systems
Drug eluting stent implantation in patients requiring concomitant vitamin K antagonist therapy. One-year outcome of the worldwide e-SELECT registry.
Sabate, Manel [> >]
Brugaletta, Salvatore [> >]
Abizaid, Alexandre [> >]
Banning, Adrian [> >]
Bartorelli, Antonio [> >]
Dzavik, Vladimir [> >]
Ellis, Stephen [> >]
Holmes, David [> >]
Gao, Runlin [> >]
Jeong, Myung Ho [> >]
Legrand, Victor mailto [Université de Liège - ULiège > Département des sciences cliniques > Cardiologie >]
Neumann, Franz-Josef [> >]
Nyakern, Maria [> >]
Spaulding, Christian [> >]
Stoll, Hans-Peter [> >]
Worthley, Stephen [> >]
Urban, Philip [> >]
International Journal of Cardiology
Yes (verified by ORBi)
[en] Anticoagulation ; Antivitamin K therapy ; Coronary stent ; Drug-eluting stent ; Hemorrhagic event ; Sirolimus-eluting stent ; Stent thrombosis
[en] BACKGROUND: Outcome of sirolimus-eluting stent (SES) in patients treated with an antivitamin K (VKA) agent before the PCI procedure is unknown. METHODS: A total of 7651 patients were selected among 15,147 recipients of SES, included in the worldwide e-SELECT registry, only from those centers which included at least one patient requiring VKA: 296 were pretreated with a VKA agent (VKA group), whereas 7355 patients from the same enrolling medical centers were not (NON-VKA group). The rates of 1) major adverse cardiac events (MACE), including all-cause deaths, myocardial infarction (MI) and target lesion revascularization, 2) stent thrombosis (ST) and 3) major bleeding (MB) in the 2 study groups were compared at 1, 6 and 12 months. RESULTS: The patients in VKA group were on average older as compared to those in NON-VKA group (67.7 +/- 9.9 vs.62.9 +/- 10.7, P<0.001). The indications for pre-procedural anticoagulation were atrial fibrillation in 177 (59.8%), presence of a prosthetic valve in 21 (7.1%), embolization of cardiac origin in 17 (5.7%), pulmonary embolism or deep vein thrombosis in 17 (5.7%), and miscellaneous diagnoses in 64 (21.6%) patients. At 1 year, the rates of MACE and MB were higher in the VKA vs. the NON-VKA group (8.3% and 3% vs. 5.3% and 1.2%, P<0.04 and P<0.002, respectively). The 1-year rates of definite and probable ST were remarkably low in both groups (0.38% vs. 1.1%, p=0.4). CONCLUSIONS: Selected patients anticoagulated with VKA agent may safely undergo SES implantation. Those patients may receive a variety of APT regimen at the cost of a moderate increased risk of MB.
Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved.

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