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(Circulation. 2001;103:2042.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Oral Anticoagulant Therapy During and After Coronary Angioplasty

The Intensity and Duration of Anticoagulation Are Essential to Reduce Thrombotic Complications

Jurriën M. ten Berg, MD; Barbara A. Hutten, Msc; Johannes C. Kelder, MD; Freek W. A. Verheugt, MD, PhD; H. W. Thijs Plokker, MD, PhD

From the Department of Cardiology (J.M.t.B., J.C.K., H.W.M.P.), St Antonius Hospital, Nieuwegein; the Department of Clinical Epidemiology and Biostatistics (B.A.H.), Academic Medical Center, Amsterdam; and the Department of Cardiology (F.W.A.V), University Medical Center St Radboud, Nijmegen, the Netherlands.

Correspondence to J.M. ten Berg, MD, Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands. E-mail jurtenberg{at}wxs.nl

Background—In the randomized Balloon Angioplasty and Anticoagulation Study (BAAS), the addition of oral anticoagulants to aspirin significantly reduced early and late events after coronary angioplasty. However, bleeding episodes were increased. The present report studied the intensity and the duration of anticoagulation as predictors of thrombotic and bleeding events.

Methods and Results—A total of 530 patients, 34% of whom received a stent, were treated with aspirin plus coumarins. Half of the patients were randomized to angiographic follow-up. The target international normalized ratio (INR) was 2.1 to 4.8 during angioplasty and 6-month follow-up. Thrombotic events were death, myocardial infarction, target lesion revascularization, and thrombotic stroke. Bleeding complications were hemorrhagic stroke, major extracranial bleeding, and false aneurysm. "Optimal" anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. There were 17 early thrombotic events (3.2%), 7 early bleeding episodes (1.3%), and 10 false aneurysms (1.9%). The incidence rate for both early thrombotic and bleeding events was lowest in patients in the target range. A total of 61 late thrombotic events occurred (11.6%). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19 to 0.57) and was associated with a 0.21 mm (95% CI, 0.17 to 0.42) larger vessel lumen at 6 months. Late bleeding episodes (1.4%) were lowest in patients in the target range.

Conclusions—Coumarins started before coronary angioplasty with a target INR of 2.1 to 4.8 led to the lowest procedural event rate, without an increase in bleeding episodes. During follow-up, optimal anticoagulation was associated with a decrease in the incidence of late events by 67% and a significant improvement in 6-month angiographic outcome.

Key Words: angioplasty • coumarins • thrombosis • complications • restenosis

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