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Circulation, Vol 76, 125-134, Copyright © 1987 by American Heart Association
ES Barnathan, JS Schwartz, L Taylor, WK Laskey, JP Kleaveland, WG Kussmaul and JW Hirshfeld Jr
To test the hypothesis that pretreatment with adequate antiplatelet therapy
reduces the likelihood of acute coronary thrombosis during routine
percutaneous transluminal coronary angioplasty (PTCA), we reviewed, blinded
to treatment group, the films and records of 300 consecutive initially
successful PTCAs. Films before PTCA, immediately after, and at least 30 min
after the last balloon inflation were assessed for the presence of any
thrombus at the PTCA site. We excluded 37 patients who received
streptokinase before PTCA or who had 100% occlusion or thrombus on pre-PTCA
films. New thrombi were classified as clinically significant (defined as
causing 100% occlusion or requiring emergency surgery or streptokinase
therapy) or as not significant (not causing an acute problem or requiring
intervention). Patients were classified into three groups, based on the
type and extent of antiplatelet therapy received. Group 1 (no aspirin, n =
121) consisted of patients who did not receive aspirin either before
admission or in hospital before PTCA (with or without dipyridamole). Group
2 (standard treatment, n = 110) received aspirin with or without
dipyridamole but did not receive both drugs before admission and in
hospital before PTCA. Group 3 (maximal treatment, n = 32) received both
aspirin and dipyridamole before admission and in hospital before PTCA. New
thrombi were detected at 39 (14.8%) PTCA sites, of which 15 (5.7% of all
PTCA sites) were considered clinically significant. Group 1 had the highest
incidence of both thrombus (21.5%) and clinically significant thrombus
(10.7%). A reduction was seen in group 2 in thrombus (11.8%; p = .07) and
in clinically significant thrombus (1.8%; p = .005). Group 3 had no
thrombus (p = .001) and no clinically significant thrombus (p = .04). In
addition to inadequate pretreatment with antiplatelet therapy, univariate
analyses demonstrated several other risk factors for thrombus: higher
percent diameter stenosis before PTCA (p less than .008), higher platelet
count (p = .013), and current smoking (p = .03). Only higher platelet count
(p less than .001) and inadequate pretreatment (p = .001) were associated
with clinically significant thrombus. Stepwise logistic regression analysis
demonstrated that for thrombus, the lack of effective antiplatelet therapy
was the most discriminatory variable, followed by current smoking, higher
percent diameter stenosis, and dissection. For clinically significant
thrombus, once the lack of pretreatment with effective antiplatelet therapy
was considered, no other factors added significant discriminatory
information.(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Aspirin and dipyridamole in the prevention of acute coronary thrombosis complicating coronary angioplasty
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