Acenocoumarol in Interventional Cardiology
Patients who have a venous graft are at risk of graft thrombosis. This can be managed with stenting of the graft. In order to prevent thrombosis during stenting and post-stenting, anticoagulants are highly effective.
The importance of adequate anticoagulation to prevent early thrombosis after stenting of stenosed venous bypass grafts
Bucx JJ et al., Am Heart J. 1991 May;121(5):1389-96.
46 stents implanted in 35 lesions of 24 consecutive patients (mean age 64 years, range 43 to 75). Two overlapping stents were implanted in seven patients, and three overlapping stents were positioned in two.
- The patients received a stringent anticoagulation therapy including:
- Antiplatelet agents – given before implantation of the stent (dipyridamole, sulfinpyrazone and salicylic acid)
- Nifedipine – before implantation & continued for 3 months
- Heparin (intravenously) before balloon dilation and continued thereafter
- Acenocoumarol – started 1-day after implantation & continued for 3 months
- After implantation, activated partial thromboplastin time was maintained at two to three times the control level by intravenous administration of heparin (24,000 IU/24 hour) until thrombotest values were reduced 5% to 10% by acenocoumarol.
- Urokinase – after implantation – 2 doses
Impending thrombotic occlusion was recognized in two suboptimally anticoagulated patients: patient A after implantation of four stents and patient B after anticoagulation therapy was discontinued because of acute upper gastrointestinal bleeding. Coronary artery bypass grafting was performed successfully in both patients. A third patient had a myocardial infarction on day 7 after stent implantation, in spite of adequate anticoagulation and optimal medical drug therapy.
It is concluded that stringent anticoagulation therapy appears mandatory to maintain graft patency after stent implantation.