Antiplatelet agents in patients undergoing percutaneous coronary intervention: how many and how much?
Antiplatelet agents play a major role in patients undergoing percutaneous coronary intervention (PCI). Stent thrombosis and the demand for improved clinical outcomes have driven the need for aggressive antiplatelet and anticoagulant regimens and newer, more efficacious, therapies. The benefits of intravenous glycoprotein (GP) IIb/IIIa antagonists and clopidogrel in high-risk patients undergoing PCI appear complementary. In low- to intermediate-risk patients, clopidogrel pre-treatment and a maintenance dose of aspirin + clopidogrel for at least 1 year after PCI are supported by the data, although the optimal duration of clopidogrel treatment beyond 1 year remains hotly contested. The next generation of clinical trials will examine the benefits of antiplatelet and antithrombotic agents as adjunctive therapy with drug-eluting stents. A better understanding of our patients' overall risk will add to procedural success and more durable outcomes.
Duffy
Brendan
B
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Bhatt
Deepak L
DL
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D000077542:Eptifibatide; D006629:Hirudins; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D010446:Peptide Fragments / Q000627:therapeutic use; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D006629:Hirudins; D007140:Immunoglobulin Fab Fragments; D010446:Peptide Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D014443:Tyrosine; D000077144:Clopidogrel; D000077466:Tirofiban; D000077542:Eptifibatide; D013988:Ticlopidine; D001241:Aspirin; C074619:bivalirudin; D000077284:Abciximab