Short-term
heparin therapy has been administered routinely after primary coronary stenting. However.
heparin therapy results in a significantly higher incidence of
bleeding and vascular complications. A new therapeutic regimen of
ticlopidine and
aspirin without further
heparin after coronary stenting in patients without AMI has been shown to be safe and reduce the incidence of
stent thrombosis. The aim of this study was to evaluate whether a new therapeutic regimen of
aspirin and
ticlopidine without
heparin is safe and effective in patients with acute
myocardial infarction (AMI) who have undergone primary coronary stenting and have Thrombolysis in
Myocardial Infarction (TIMI) grade 3 flow in the
infarct-related artery. Between January 1997 and September 1999, one hundred and fifty two consecutive patients with AMI on Killip score 1 or 2 who underwent primary coronary stenting resulting in TIMI grade 3 flow were enrolled and divided into two groups: Group 1 (n = 95 patients) received
aspirin,
ticlopidine and further intravenous
heparin infusion for 48 hours following primary coronary stenting; Group 2 (n = 57 patients) received only
aspirin and
ticlopidine without further
heparin therapy following primary coronary stenting. No in-hospital major
cardiac events were observed in either group. However, the combined incidence of
bleeding and vascular complications (27.4% vs 12.3%, p = 0.029) and the need for
blood transfusions (9.5% vs 0%, p = 0.013) were significantly higher in Group I patients. Furthermore,
hospital stay was also longer in Group I patients (5.8+/-2.4 vs 4.7+/-1.7 days, p = 0.0003). At the 30-day follow-up, there were no differences (1.05% vs 0%, p = 0.63) in the combined incidence of vascular complications and the major
cardiac events were similar (1.05% vs 1.75%, p = 0.71) between the groups. The results suggest that further
heparin therapy following primary coronary stenting increases the combined incidence of
bleeding and vascular complications as well as the need for
blood transfusions and prolongs the length of
hospital stay without further benefit to those patients with coronary flow restored to TIMI 3 grade flow.