May 052011

Rubboli et al summarize the (weak) evidence and current guidelines. General avoidance of drug-eluting stents in those with need of long-term warfarin is still the party-line recommendation, with triple therapy (warfarin, aspirin, clopidogrel) for those who receive a DES due to a strong indication. While TT is clearly superior for high risk patients (e.g., mechanical valve), the net benefit is less clear for those with either a high HAS-BLED bleeding risk score or a low CHADS2 stroke risk score of 0-1. Flawed evidence suggests that most of the increased bleeding on TT (over and above the bleeding risk from warfarin with one antiplatelet agent) is "minor." CHEST 2011;139:981-987.

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What’s the best long-term anticoagulation Rx after a stent for people needing warfarin?