Debate of adjunctive pharmacology for percutaneous coronary intervention: thrombin inhibitors and clopidogrel are enough.
The role of adjunctive pharmacology for percutaneous coronary intervention (PCI) has been extensively studied, but controversy remains regarding the optimal regimen. While older studies suggest that glycoprotein IIb/IIIa inhibitors (GPI) should be routinely administered, much of this evidence was collected prior to the era of widespread stenting and thienopyridine use. There is now substantial clinical evidence that bivalirudin monotherapy is the optimal adjunctive pharmacology for the vast majority of patients undergoing elective or urgent percutaneous coronary intervention (PCI), including those presenting with an acute coronary syndrome (ACS). Bivalirudin monotherapy provides similar protection from ischemic complications with a reduced rate of major hemorrhage, resulting in a superior net clinical outcome compared with the use of GPI.
Yehudai
Loran
L
Division of Cardiology, New York University School of Medicine, New York, New York, USA.
Feit
Frederick
F
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use; D000991:Antithrombins / Q000494:pharmacology* / Q000627:therapeutic use; D000077144:Clopidogrel; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000188:drug therapy / Q000628:therapy*; D006493:Heparin / Q000494:pharmacology / Q000627:therapeutic use; D006629:Hirudins / Q000494:pharmacology; D006801:Humans; D010446:Peptide Fragments / Q000494:pharmacology / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; C074619:bivalirudin