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(Circulation. 2000;101:e46.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Safety and Efficacy of Ticlopidine After Stent Placement

Patrick Henry, MD, PhD; Fabrice Beverelli, MD

Service de Cardiologie, Hôpital Broussais, Hôptial Lariboisiere, Paris, France

	Introduction

 
To the Editor:

We have read with interest the article by Dr Berger and colleagues regarding safety and efficacy of ticlopidine for only 2 weeks after successful intracoronary stent placement.¹ The authors conclude that "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." In our opinion, 3 major points need to be discussed regarding this conclusion.

First, the authors point out that intravascular ultrasound study (IVUS) was used "to facilitate stent placement in 73 patients (8.8%)." IVUS led to additional treatment (additional balloon inflation or placement of additional stents) in 36 patients. This point is crucial and needs to be discussed. Colombo and coworkers² first demonstrated that optimization of stent implantation was a key issue in the prevention of subacute occlusion. Albiero et al³ demonstrated that stent thrombosis and other adverse events were not significantly different between the aspirin and the ticlopidine-plus-aspirin groups when stent expansion, controlled by IVUS, was adequate. The reasons that led to IVUS examination are not clearly defined in the article by Berger et al.¹ We can hypothesize that IVUS was performed when the result was not satisfactory, eg, suboptimal final result, persistent slow flow or dissection, or persistent intraluminal defect. Therefore, several patients with a high risk of stent thrombosis before IVUS could be treated with aspirin alone after optimization.

Second, the rate of unstable coronary syndromes is not clearly mentioned in the article by . . . [Full Text of this Article]

Peter B. Berger, MD; Malcolm R. Bell, MB, BS; David Hasdai, MD; David R. Holmes, Jr, MD; Steve Melby, RN; Diane Grill, MS

Mayo Clinic, Rochester, Minn