Thienopyridines in percutaneous coronary interventions: standard procedures and high risk subsets.
Due to the significant clinical and economic consequences of subacute stent thrombosis and the use of more complex devices (brachytherapy, drug eluting stents) in a variety of clinical situations (i.e. acute coronary syndromes), initiation and duration of a combined antiplatelet therapy using aspirin and a thienopyridine drug has become an issue of ongoing discussion in interventional cardiology. This review will provide a short introduction into the pathophysiology of stent thrombosis before standard procedures and critical issues on the use of thienopyridines in the setting of coronary interventions are discussed. Furthermore, clinically relevant issues that are not clearly covered by recommendations or guidelines like thienopyridines after coronary interventions in patients on chronic oral anticoagulation are also addressed.
Radke
Peter W
PW
Medical Clinic II, University of Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany. radke@innere2.uni-luebeck.de
Hoffmann
Rainer
R
Zernecke
Alma
A
Kaiser
Axel
A
Schunkert
Heribert
H
Weber
Christian
C
D015906:Angioplasty, Balloon, Coronary; D001672:Biocompatible Materials; D001918:Brachytherapy; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008670:Metals / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D001672:Biocompatible Materials; D008670:Metals; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine