Drug insight: antithrombotic therapy after percutaneous coronary intervention in patients with an indication for anticoagulation.
Antiplatelet therapy with aspirin and clopidogrel is standard care following revascularization by percutaneous coronary intervention with stent insertion. This so-called dual therapy is recommended for up to 4 weeks after intervention for bare-metal stents and for 6-12 months after intervention for drug-eluting stents. Although it is estimated that 5% of patients undergoing percutaneous coronary intervention require long-term anticoagulation because of an underlying chronic medical condition, continuing treatment with triple therapy (warfarin, aspirin and clopidogrel) increases the risk of bleeding. In most patients triple antithrombotic therapy seems justified for a short period of time. In some patients, however, a more considered judgment based on absolute need for triple therapy, risk of bleeding and risk of stent thrombosis is required, but the optimum antithrombotic treatment for these patients who require long-term anticoagulation has not been defined. This Review summarizes the existing literature concerning antithrombotic therapy and makes recommendations for initiation and duration of triple therapy in the small proportion of patients already receiving anticoagulant therapy who require percutaneous coronary intervention.
Helft
Gérard
G
Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Boulevard de l'Hôpital, 75013 Paris, France. gerard.helft@psl.aphp.fr
Gilard
Martine
M
Le Feuvre
Claude
C
Zaman
Azfar G
AG
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin