Therapeutic strategies after coronary stenting in chronically anticoagulated patients: the MUSICA study

TLDR

The study aimed to characterize the antithrombotic regimens prescribed at discharge for patients on oral anticoagulants undergoing PCI‑S and to evaluate their safety and efficacy according to thromboembolic risk. A prospective multicentre registry enrolled 405 OAT patients who received PCI‑S across nine Spanish and one UK tertiary hospitals, with follow‑up conducted after discharge via telephone. Triple therapy was most common but produced the highest bleeding rate; dual antiplatelet therapy alone had the lowest bleeding and comparable efficacy in low‑risk patients, suggesting triple therapy should be reserved for moderate‑to‑high risk cases.

Abstract

<h3>Objectives:</h3> To identify the therapeutic regimens used at discharge in patients receiving oral anticoagulant therapy (OAT) who undergo stenting percutaneous coronary intervention and stent implantation (PCI-S), and to assess the safety and efficacy associated with different therapeutic regimens according to thromboembolic risk. <h3>Design:</h3> A prospective multicentre registry. <h3>Setting:</h3> In hospital, after discharge and follow-up by telephone call. <h3>Patients and methods:</h3> 405 patients (328 male/77 female; mean (SD) age 71 (9) years) receiving OAT who underwent PCI-S between November 2003 and June 2006 from nine catheterisation laboratories of tertiary care teaching hospitals in Spain and one in the United Kingdom were included. <h3>Results:</h3> Three therapeutic regimens were identified at discharge: triple therapy (TT)—that is, any anticoagulant (AC) plus double antiplatelet therapy (DAT; 278 patients (68.6%); AC and a single antiplatelet (AC+AT; 46 (11.4%)) and DAT only (81 (20%)). At 6 months, patients receiving TT showed the greatest rate of bleeding events. No patients receiving DAT at low thromboembolic risk presented a bleeding event (14.8% receiving TT, 11.8% receiving AC+AT and 0% receiving DAT, p = 0.033) or cardiovascular event (6.7% receiving TT, 0% receiving AC+AT and 0% receiving DAT, p = 0.126). The combination of AC+AT showed the worst rate of adverse events in the whole cohort, especially in patients at moderate–high thromboembolic risk. <h3>Conclusions:</h3> In patients receiving OAT, TT was the most commonly used regimen after PCI-S. DAT was associated with the lowest rate of bleeding events and a similar efficacy to TT in patients at low thromboembolic risk. TT should probably be restricted to patients at moderate–high thromboembolic risk.