(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
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