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(Circulation. 1997;95:1145-1156.)
© 1997 American Heart Association, Inc.

Articles

Results of a Consecutive Series of Patients Receiving Only Antiplatelet Therapy After Optimized Stent Implantation

Comparison of Aspirin Alone Versus Combined Ticlopidine and Aspirin Therapy

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

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

Correspondence to Antonio Colombo, MD, Centro Cuore Columbus, Via M. Buonarroti 48, 20145 Milan, Italy. E-mail albire{at}chiostro.univr.it

Background Previous studies have shown that stents can be inserted in coronary arteries of patients who are subsequently treated safely with antiplatelet therapy only (ticlopidine and/or aspirin) with a low incidence of stent thrombosis, provided that stent expansion is adequate and there are no other flow-limiting lesions present. However, it is unknown whether ticlopidine combined with aspirin is superior to aspirin alone in preventing stent thrombosis.

Methods and Results From March 1993 through July 1995, 801 consecutive patients assigned to receive either aspirin therapy alone (ASA, 264 patients, 348 lesions) or a combination of ticlopidine and aspirin (TIC-ASA, 537 patients, 737 lesions) after a successful stent insertion, in most accomplished with intravascular ultrasound guidance, were evaluated retrospectively. At 1 month, there was no difference in the ASA group compared with the TIC-ASA group in the rate of any stent thrombosis (1.9% versus 1.9%; P=1), subacute stent thrombosis (1.9% versus 1.3%; P=.5), cumulative major adverse clinical events (1.9% versus 2.0%; P=1), and peripheral vascular complications (0.5% versus 0.2%; P=.3). Medication side effects that required termination of antiplatelet therapy occurred only in 1.9% of patients in the TIC-ASA group (P=.04).

Conclusions At 1-month clinical follow-up, stent thrombosis and other adverse clinical outcomes were not significantly different between the ASA and TIC-ASA groups. Medication side effects occurred only in patients treated with ticlopidine. These results provide further evidence of the safety of treatment with antiplatelet therapy only after optimal stent implantation and support the efficacy of aspirin alone in preventing stent thrombosis.

Key Words: stents • ultrasonics • platelet aggregation inhibitors • coronary disease • aspirin

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