Untersuchung von Krankenhauskomplikationen nach elektiver perkutaner transluminaler Koronarangioplastie bei kombinierter Vorbehandlung mit Ticlopidin und Azetylsalizylsäure
The effects of a premedication of aspirin and ticlopidine combined with an increased use of coronary artery stenting in percutaneous transluminal coronary angioplasty (PTCA) was examined. Study endpoints were procedural success, the rate of PTCA-induced complications (necessity of reintervention, myocardial infarction, death, ischemic and hemorrhagic complications) and the rate of subacute stent thrombosis in elective PTCA procedures. Methods: In this retrospective study 1109 patients (group A, 1993/94) treated with aspirin (100 milligrams per day) alone combined with a low stent implantation rate (1.8 %) were compared with 843 patients (group B, 1995) with a premedication of aspirin (100 milligrams per day) and ticlopidine (500 milligrams per day) combined with a higher stent implantation rate (17.8 %). Oral anticoagulation was initiated when a stent was implanted in group A whereas the combined medication was continued in case of stent implantation in group B. Procedural success, necessity of reintervention, myocardial infarction, death, ischemic and hemorrhagic complications as well as the rate of subacute stent thrombosis were recorded. Results: The reintervention rate was significantly reduced in group B compared with group A (4.2 % vs. 2.1 %, p<0.025). Myocardial infarction and death were reduced (infarction: 1.0 % vs. 0.7 %, death: 0.3 % vs. 0.2 %). Likelihood of surgical coronary artery bypass was lower in group B (0.8 % vs. 0.4 %, p<0.25). There was no difference in hemorrhage among both groups (2.0 % vs. 1.9 %). The composite endpoint of all PTCA-induced complications was significantly less frequent in group B than group A (8.2 % vs. 4.0 %, p<0.05). The rate of subacute stent thrombosis was low in the group with the combined premedication (3.3 % of all stent implantations). Two of 843 patients showed allergic reaction towards ticlopidine (0.2 %). Both were resolved without complications when drug was withheld. None of the patients experienced hematological deviations from normal values with regard to blood count during in-hospital stay. Conclusions: The pre-treatment with a combination of aspirin and ticlopidine combined with a higher stent implantation rate lead to a significant reduction of reinterventions and bypass operations without an ascent of bleeding complications. Also patients without planned stent implantation benefit from a combined premedication with aspirin and ticlopidine. In order to take the delayed effect of ticlopidine on platelet aggregation into account ticlopidine medication can be safely initiated at least one day before planned PTCA.
info:eu-repo/classification/ddc/610, Medizin, ptca, stent, ass, aspirin, ticlopidin, stentthrombose
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