Prophylaxis of Thromboembolic Events in Patients With Atrial Fibrillation After Coronary Stent Implantation, A Retrospective Analysis of 30-days Bleeding and Embolic Events

Prophylactic oral anticoagulation is indicated in patients with Atrial Fibrillation (AF) and high risk for thrombembolic events. The anticoagulant regimen is not standardized for patients with AF after coronary stenting, which requires dual antiplatelet therapy comprising aspirin and ADP -antagonists for at least four Weeks. Low Molecular Weight Heparin (LMWH) is widely used in these patients.We retrospectively compared two groups of patients with permanent AF who underwent coronary stent implantation. 47 patients in group I received 320 mg aspirin Once Daily (OD) and 250 mg ticlopidine twice daily (BID) for four weeks without additional anticoagulantion. In group II 11 patients received 320 mg aspirin OD, 250 mg ticlopidine BID and additionaly subcutaneously administered LMWH in a therapeutic dosage. Within four weeks after coronary intervention, 5 vascular or bleeding complications occured in group I (8%) and 4 in group II (36%) (p=0.035 by Fisher`s exact test). One embolic event was observed in group I, whereas no embolic event occured in group II (p=0.08).The results of our study suggest that the combination of dual antiplatelet therapy in addition to anticoagulation with LMWH may significantly raise the risk of vascular and bleeding events in patients with AF after coronary stent implantation. However, as we observed one embolic event in the patients without additional anticoagulation, data from a prospective randomized trial are needed in order to clarify the optimal therapeutic approach to patients with AF undergoing coronary stent implantation.