[Is stent thrombosis the new Achilles heel of interventional cardiology? State of the Art clinical trials, causes and approaches for prevention].
Coronary stents are the mainstay of percutaneous coronary intervention. Stent thrombosis is a potentially catastrophic and often life-threatening complication. If it occurs it presents in up to 80% as myocardial infarction, about half of the affected patients die from this complication. The dual antiplatelet therapy has markedly reduced its occurrence. Today, stent thrombosis occurs in <1%, usually as a delayed event; but compared to bare metal stents the overall incidence has not increased in meta-analyses of randomized trials. The advent of drug-eluting stents (DES) has raised concerns regarding the occurrence of delayed stent thrombosis. Delayed arterial wall healing as well as prothrombotic characteristics of the drug eluting stent itself may contribute to stent thrombosis. In order to prevent stent thrombosis a standardized fixed dose antiplatelet therapy with ASA and clopidogrel is recommended. But, their efficacy depends on patient's individual characteristics such drug metabolism. Therefore, individual determination of platelet function in each patient undergoing stent implantation may help to avoid prothrombotic as well as bleeding complications.
Grumann
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T
Abteilung III für Kardiologie und Angiologie, Medizinische Universititäsklinik, Hugstetterstrasse 55, 79106 Freiburg. thorsten.grumann@uniklinik-freiburg.de
Diehl
P
P
Bode
C
C
Moser
M
M
D002986:Clinical Trials as Topic; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D008854:Microscopy, Electron; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D015912:Thrombolytic Therapy
D010975:Platelet Aggregation Inhibitors