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(Circulation. 1996;93:215-222.)
© 1996 American Heart Association, Inc.

Articles

A Randomized Comparison of Combined Ticlopidine and Aspirin Therapy Versus Aspirin Therapy Alone After Successful Intravascular Ultrasound–Guided Stent Implantation

Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994, and published in abstract form in Circulation (1994;90[pt 2]:I-124).

Patrick Hall, MD; Shigeru Nakamura, MD; Luigi Maiello, MD; Akira Itoh, MD; Simonetta Blengino, MD; Giovanni Martini, CCP; Massimo Ferraro, RT; Antonio Colombo, MD

From Centro Cuore Columbus, Milan, Italy, and Toho University Ohashi Hospital, Third Department of Internal Medicine (S.N.), Tokyo, Japan.

Correspondence to Antonio Colombo, MD, Centro Coure Columbus, Via M Buonarotti 48, Milan 20145, Italy.

Background Previous studies have shown that it is feasible to withhold anticoagulation after a successful intracoronary stent procedure with a low incidence of stent thrombosis. The importance of specific antiplatelet agents when stenting is performed without anticoagulation is unknown.

Methods and Results After successful intravascular ultrasound–guided stenting, 226 patients were randomly assigned to receive either aspirin therapy alone (n=103) or a combination of ticlopidine and short-term aspirin therapy (n=123). Primary angiographic and clinical end points were stent thrombosis, death, myocardial infarction, the need for postprocedure coronary artery bypass surgery or repeated angioplasty, and significant medication side effects requiring termination of the medication within the first month of a successful procedure. At 1 month, the rate of stent thrombosis was 2.9% in the aspirin only group and 0.8% in the ticlopidine-aspirin group (P=.2). Cumulative major clinical events after successful stenting occurred in 3.9% of the patients in the aspirin group and in 0.8% in the ticlopidine-aspirin group (P=.1). There were no medication side effects in the aspirin group; in the combined ticlopidine-aspirin group, medication side effects occurred in 3 patients (P=.2).

Conclusions At 1 month, there was no difference in the incidence of stent thrombosis or other clinical end points between the two poststent antiplatelet regimens. However, the relatively small size of the study and the low incidence of thrombosis events may have contributed to the failure to detect differences in angiographic and clinical end points between the two groups.

Key Words: stents • ultrasonics

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