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In-Hospital Management and Outcome of Patients on Warfarin Undergoing Coronary Stent Implantation: Results of the Multicenter, Prospective WARfarin and Coronary STENTing (WAR-STENT) Registry.
MedLine Citation:
PMID:  23549489     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The in-hospital management of patients on warfarin undergoing coronary stent implantation (PCI-S) is variable, and the in-hospital outcome incompletely defined. To determine the adherence to the current recommendations, and the incidence of adverse events, we carried out the prospective, multicenter, observational WARfarin and coronary STENTing (WAR-STENT) registry (ClinicalTrials.gov identifier NCT00722319). All consecutive patients on warfarin undergoing PCI-S at 37 Italian centers were enrolled and followed for 12 months. Outcome measures were: major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction, need for urgent revascularization, stroke, and venous thromboembolism, and major and minor bleeding. In this paper, we report the in-hospital findings. Out of the 411 patients enrolled, 92% were at non-low (ie, moderate or high) thromboembolic risk. The radial approach and bare-metal stents were used in 61% and 60% of cases, respectively. Drug-eluting stents were essentially reserved to patients with diabetes, which in turn, significantly predicted the implantation of drug-eluting stents (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.29-3.17; P=.002). The in-hospital MACE and major bleeding rates were 2.7% and 2.1%, respectively. At discharge, triple therapy (TT) of warfarin, aspirin, and clopidogrel was prescribed to 76% of patients. Prescription of TT was significantly more frequent in the non-low thromboembolic risk group. Non-low thromboembolic risk, in turn, was a significant predictor of TT prescription (OR, 11.2; 95% CI, 4.83-26.3; P<.0001). In conclusion, real-world warfarin patients undergoing PCI-S are largely managed according to the current recommendations. As a consequence, the risk of in-hospital MACE and major bleedings appears limited and acceptable.
Authors:
Andrea Rubboli; Alessandro Sciahbasi; Carlo Briguori; Francesco Saia; Cataldo Palmieri; Luigi Andrea Moroni; Paolo Calabrò; Antonio Maria Leone; Nicoletta Franco; Marco Valgimigli; Elisabetta Varani; Michela Santi; Paola Pasqualini; Alessandro Capecchi; Giacomo Piccalò; Massimo Margheri; Giuseppe Di Pasquale; Marcello Galvani; Leonardo Bolognese; Lucio Gonzini; Aldo Pietro Maggioni
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  25     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  170-6     Citation Subset:  IM    
Affiliation:
Unità Operativa di Cardiologia, Laboratorio di Cardiologia Interventistica, Ospedale Maggiore, Bologna, Italy. andrearubboli@libero.it.
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