(Circulation. 2000;102:386.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of Coumarins Started Before Coronary Angioplasty on Acute Complications and Long-Term Follow-Up
A Randomized Trial
Presented in part at the 21st Congress of the European Society of Cardiology (Hotline-1), Barcelona, Spain, August 28 through September 1, 1999, and the 72nd Scientific Sessions of the American Heart Association, Atlanta, Ga, November 7–10, 1999.
From the Department of Interventional Cardiology, St Antonius Hospital, Nieuwegein, and the University Hospital Nijmegen St Radboud (F.W.A.V), Netherlands.
Correspondence to J.M. ten Berg, MD, Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, Netherlands. E-mail jurtenberg{at}wxs.nl
Background—Coronary angioplasty frequently creates a thrombogenic surface, with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. The objective of this open, randomized trial was to assess the clinical effect of coumarins started before coronary angioplasty and continued for 6 months.
Methods and Results—Before coronary angioplasty, 530 patients were randomly assigned to aspirin plus coumarins and 528 patients to aspirin alone. At the start of the angioplasty, the mean international normalized ratio was 2.7±1.1; during follow-up, it was 3.0±1.1. At 30 days, the composite end point of death, myocardial infarction, target-lesion revascularization, and stroke was observed in 18 patients (3.4%) treated with aspirin plus coumarin compared with 34 patients (6.4%) treated with aspirin alone (relative risk, 0.53; 95% CI, 0.30 to 0.92). At 1 year, these figures were 14.3% and 20.3%, respectively (relative risk, 0.71; 95% CI, 0.54 to 0.93). The incidence of major bleeding and false aneurysm during hospitalization was 3.2% and 1.0%, respectively (relative risk, 3.39; 95% CI, 1.26 to 9.11). The benefit of coumarins was observed in both stented and nonstented patients.
Conclusions—Coumarins in addition to aspirin started before PTCA and continued for 6 months was more effective than aspirin alone in the prevention of acute and late complications after coronary angioplasty. This benefit was accompanied by a small but significant increase in bleeding complications.
Key Words: angioplasty • warfarin sodium • anticoagulants
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