Triple versus dual antiplatelet therapy after coronary stenting: Impact on stent thrombosis

Seung Whan Lee, Seong Wook Park, Myeong Ki Hong, Young Hak Kim, Bong Ki Lee, Jong Min Song, Ki Hoon Han, Cheol Whan Lee, Duk Hyun Kang, Jae Kwan Song, Jae Joong Kim, Seung Jung Park

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Abstract

OBJECTIVES: We evaluated safety and efficacy of triple antiplatelet therapy with aspirin, clopidogrel, or ticlopidine and cilostazol after coronary stenting. BACKGROUND: Triple antiplatelet therapy might have beneficial effect to prevent thrombotic complications in patients undergoing coronary stenting. METHODS: Patients undergoing successful coronary stenting were divided into dual antiplatelet therapy (aspirin plus clopidogrel or ticlopidine, group I, n = 1,597) and triple antiplatelet therapy (aspirin plus clopidogrel or ticlopidine plus cilostazol, group II, n = 1,415) groups. The primary end point included death, myocardial infarction, target lesion revascularization, or stent thrombosis within 30 days. The secondary end point was side effects of study drugs, including major bleeding, vascular complication, hepatic dysfunction, and hematological complications. RESULTS: Multi-vessel stenting and the use of long stents were more prevalent in group II than in group I. The primary end point was 0.8% in group I and 0.3% in group II (p = 0.085). Stent thrombosis within 30 days was significantly lower in group II (n = 1, 0.1%) than in group I (n = 9, 0.5%; p = 0.024). The independent predictors of stent thrombosis were primary stenting (odds ratio [OR] 7.9, 95% confidence interval [CI] 2.0 to 30.8, p = 0.003) and triple therapy (OR 0.12, 95% CI 0.015 to 0.98, p = 0.048). The overall adverse drug effects, including major bleeding, neutropenia, and thrombocytopenia, were no different between two groups (1.8% vs. 2.6%, p = 0.104). CONCLUSIONS: Compared with the dual antiplatelet regimen, triple antiplatelet therapy seemed to be more effective in preventing thrombotic complications after stenting without an increased risk of side effects. Triple antiplatelet therapy might be safely applied in patients or lesions with a high risk of stent thrombosis.

Original languageEnglish
Pages (from-to)1833-1837
Number of pages5
JournalJournal of the American College of Cardiology
Volume46
Issue number10
DOIs
Publication statusPublished - 2005 Nov 15

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Lee, S. W., Park, S. W., Hong, M. K., Kim, Y. H., Lee, B. K., Song, J. M., Han, K. H., Lee, C. W., Kang, D. H., Song, J. K., Kim, J. J., & Park, S. J. (2005). Triple versus dual antiplatelet therapy after coronary stenting: Impact on stent thrombosis. Journal of the American College of Cardiology, 46(10), 1833-1837. https://doi.org/10.1016/j.jacc.2005.07.048