computed tomography; (5) venous thromboembolism: signs/ symptoms of ..... S. Bortolo, Vicenza; Davide D'Andrea, Ospedale V. Cardarelli, Napoli;. Salvatore ...
Original Contribution
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 Andrea Rubboli, MD1, Alessandro Sciahbasi, MD2, Carlo Briguori, MD3, Francesco Saia, MD4, Cataldo Palmieri, MD5, Luigi Andrea Moroni, MD6, Paolo Calabrò, MD7, Antonio Maria Leone, MD8, Nicoletta Franco, MD9, Marco Valgimigli, MD10, Elisabetta Varani, MD11, Michela Santi, MD12, Paola Pasqualini, MD13, Alessandro Capecchi, MD14, Giacomo Piccalò, MD15, Massimo Margheri, MD11, Giuseppe di Pasquale, MD1, Marcello Galvani, MD16, Leonardo Bolognese, MD17, Lucio Gonzini, BSc18, Aldo Pietro Maggioni, MD18 In patients on warfarin undergoing coronary stent implantation (PCI-S), the actual uptake of the periprocedural recommendations to prefer the radial access site, continue warfarin throughout PCI-S, avoid glycoprotein (GP) IIb/IIIa inhibitors, and prefer bare-metal stents (BMSs),1-3 is incompletely defined. The incidence of in-hospital adverse events, which may be influenced by the above variables, is incompletely defined as well. While definite estimation of the rate of in-hospital adverse events, and especially bleeding, is of great importance for a reliable estimation of the adverse event rate recorded at the end of follow-up, no large studies focused on the in-hospital management and outcome. Moreover, the in-hospital adverse event rate has seldom been reported separately.4-7 Finally, most of the available data derive from retrospective, single-center, and small-sized studies.1-3 To investigate the contemporary management of patients on warfarin undergoing PCI-S, and to determine the incidence of adverse events in a real-world setting, we carried out the WARfarin and coronary STENTing (WAR-STENT) registry. In this paper, the findings of the in-hospital phase are reported, whereas the postdischarge observations will be the object of a subsequent analysis.
J INVASIVE CARDIOL 2013;25(4):170-176
The WAR-STENT registry is a prospective, multicenter, observational study including consecutive patients on warfarin undergoing PCI-S (ClinicalTrials.gov identifier NCT00722319). The only inclusion criterion was ongoing warfarin at the time of PCI-S, or when PCI-S was planned. Due to the observational design, no exclusion criteria were provided, except for the patient’s refusal to participate. At each center, patients were treated according to local policies, and were followed for 12 months. Ethic committees of each participating center approved the study protocol, and written informed consent was obtained from each patient. Outcome measures were: (1) incidence of major adverse cardiovascular events (MACE), including cardiovascular death, non-fatal myocardial infarction (MI), need for urgent revascularization, stroke, and venous thromboembolism; and (2) incidence of major and minor bleeding, both in-hospital and at 12 months.
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. 3 se 01 lU 2 na MP so H er ht r P rig Fo opy
Abstract: 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
