(Circulation. 1999;99:248-253.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Safety and Efficacy of Ticlopidine for Only 2 Weeks After Successful Intracoronary Stent Placement
From the Division of Cardiovascular Diseases, Department of Internal Medicine (P.B.B., M.R.B., D.H., S.M., D.R.H.), and the Section of Biostatistics (D.E.G.), Mayo Clinic, Rochester, Minn.
Correspondence to Peter B. Berger, MD, Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail berger.peter{at}mayo.edu
Background—In patients receiving intracoronary stents, stent thrombosis is reduced when ticlopidine therapy is combined with aspirin after the procedure. However, ticlopidine causes neutropenia in 1% of patients when administered for >2 weeks, and little is known about the duration that ticlopidine needs be administered to prevent stent thrombosis.
Methods and Results—We analyzed 827 patients
undergoing successful stent placement in 1061 coronary segments
at Mayo Clinic who were treated between May 1, 1996, and October 31,
1997. Chronic warfarin therapy, cardiogenic shock, and enrollment in
research protocols requiring 4 weeks of ticlopidine were exclusion
criteria; ticlopidine was discontinued after 14 days in all remaining
patients. The mean age of the study population was 64±11 years;
49% had suffered a prior infarction, 20% had undergone
coronary artery bypass surgery, and 65% had multivessel
disease. The indication for stent placement was dissection or abrupt
closure in 31% of patients and suboptimal results from balloon
angioplasty in 18%. Placement was elective in 51% of patients, and
10.3% of patients were treated within 12 hours of an acute myocardial
infarction. Mean nominal stent size was 3.3±0.5 mm. High-pressure
inflations (
12 atm) were performed in all patients (mean, 17±4 atm).
Intravascular ultrasound was used to facilitate stent placement in
8.8% of patients. Abciximab was administered to 38% of patients; 11%
of patients who were at increased risk of stent thrombosis were treated
with enoxaparin for 10 to 14 days. Adverse
cardiovascular events in the 14 days after stent
placement occurred in 11 patients (1.3%). Two patients died of
nonischemic causes (sepsis and renal failure) in the 15th
through 30th days after ticlopidine was stopped. However, there were no
cardiovascular deaths, myocardial infarctions,
coronary artery bypass operations, or repeat angioplasty
procedures between the 15th and 30th days; stent thrombosis did not
occur in any patient after ticlopidine had been stopped. No patient
developed neutropenia, although 1.8% of the first 489 patients who
were closely monitored for side effects from ticlopidine developed side
effects requiring its discontinuation, and milder side effects occurred
in 4.7%.
Conclusions—In patients receiving intracoronary stents, the discontinuation of ticlopidine therapy 14 days after stent placement is associated with a very low frequency of stent thrombosis and other adverse events.
Key Words: stents • angioplasty • thrombosis • platelet aggregation inhibitors • ticlopidine
This article has been cited by other articles:
 |
|
 |
|
  American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, L. A. Fleisher, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery J. Am. Coll. Cardiol., November 24, 2009; 54(22): e13 - e118. [Full Text] [PDF]
|
|
|
|
 |
|
 2007 WRITING COMMITTEE MEMBERS, L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, November 24, 2009; 120(21): e169 - e276. [Full Text] [PDF]
|
|
|
|
 |
|
 K. N. Saxena, S. Kumar, B. Taneja, and P. Gaba Non-cardiac surgery 2 weeks after percutaneous cardiac intervention Br. J. Anaesth., May 1, 2009; 102(5): 719 - 720. [Full Text] [PDF]
|
|
|
|
 |
|
 L. T. Newsome, R. S. Weller, J. C. Gerancher, M. A. Kutcher, and R. L. Royster Coronary Artery Stents: II. Perioperative Considerations and Management Anesth. Analg., August 1, 2008; 107(2): 570 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Developed in Collaboration With the American Socie, WRITING COMMITTEE MEMBERS, L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Anesth. Analg., March 1, 2008; 106(3): 685 - 712. [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1707 - 1732. [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242. [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): 1971 - 1996. [Full Text] [PDF]
|
|
|
|
|
|
R. A. Harrington and R. M. Califf Late Ischemic Events After Clopidogrel Cessation Following Drug-Eluting Stenting: Should We Be Worried? J. Am. Coll. Cardiol., November 1, 2006; (2006) j.jacc.2006.10.025v2. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Spertus, R. Kettelkamp, C. Vance, C. Decker, P. G. Jones, J. S. Rumsfeld, J. C. Messenger, S. Khanal, E. D. Peterson, R. G. Bach, et al. Prevalence, Predictors, and Outcomes of Premature Discontinuation of Thienopyridine Therapy After Drug-Eluting Stent Placement: Results From the PREMIER Registry Circulation, June 20, 2006; 113(24): 2803 - 2809. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Buresly, M. J. Eisenberg, X. Zhang, and L. Pilote Bleeding Complications Associated With Combinations of Aspirin, Thienopyridine Derivatives, and Warfarin in Elderly Patients Following Acute Myocardial Infarction Arch Intern Med, April 11, 2005; 165(7): 784 - 789. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Wilson, P. Fasseas, J. L. Orford, R. J. Lennon, T. Horlocker, N. E. Charnoff, S. Melby, and P. B. Berger Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting J. Am. Coll. Cardiol., July 16, 2003; 42(2): 234 - 240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Berger and S. Steinhubl Clinical Implications of Percutaneous Coronary Intervention-Clopidogrel in Unstable angina to prevent Recurrent Events (PCI-CURE) Study: A US Perspective Circulation, October 22, 2002; 106(17): 2284 - 2287. [Full Text] [PDF]
|
|
|
|
|
|
M. Taniuchi, H. I. Kurz, and J. M. Lasala Randomized Comparison of Ticlopidine and Clopidogrel After Intracoronary Stent Implantation in a Broad Patient Population Circulation, July 31, 2001; 104(5): 539 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Schuhlen, A. Kastrati, J.u. Pache, J. Dirschinger, and A. Schomig Incidence of thrombotic occlusion and major adverse cardiac events between two and four weeks after coronary stent placement: analysis of 5,678 patients with a four-week ticlopidine regimen J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2066 - 2073. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Popma, E. M. Ohman, J. Weitz, A. M. Lincoff, R. A. Harrington, and P. Berger Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention Chest, January 1, 2001; 119 (2009): 321S - 336S. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Brodison, R. Katira, R. S More, and A. Chauhan Current practice: Antiplatelet use in interventional cardiology Postgrad. Med. J., February 1, 2000; 76(892): 70 - 79. [Abstract] [Full Text]
|
|
|
|
|
|
P. Henry, F. Beverelli, P. B. Berger, M. R. Bell, D. Hasdai, D. R. Holmes Jr, S. Melby, and D. Grill Safety and Efficacy of Ticlopidine After Stent Placement • Response Circulation, January 25, 2000; 101 (3): e46 - e47. [Full Text] [PDF]
|
|
|
|
|
|
P. B. Berger, M. R. Bell, C. S. Rihal, H. Ting, G. Barsness, K. Garratt, V. Bellot, V. Mathew, S. Melby, L. Hammes, et al. Clopidogrel versus ticlopidine after intracoronary stent placement J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1891 - 1894. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Costa, M. Sabate, W. J. van der Giessen, I. P. Kay, P. Cervinka, J. M. R. Ligthart, P. Serrano, V. L. M. A. Coen, P. C. Levendag, and P. W. Serruys Late Coronary Occlusion After Intracoronary Brachytherapy Circulation, August 24, 1999; 100(8): 789 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Chambers, S. T Riebel, and M. Kozak Interventional Cardiology: Advances in Percutaneous Techniques for the Treatment of Cardiac Disease Seminars in Cardiothoracic and Vascular Anesthesia, July 1, 1999; 3(2): 109 - 125. [Abstract] [PDF]
|
|