title: The problem of persistent platelet activation in acute coronary syndromes and following percutaneous coronary intervention.
abstract: Platelets play a central role in the atherosclerotic inflammatory response, thrombotic vascular occlusion, microembolization, vasoconstriction, and plaque progression. Persistent platelet activation poses a serious problem among patients with acute coronary syndromes (ACS) and those who have undergone percutaneous coronary intervention (PCI), placing them at risk for ischemic events and subacute stent thrombosis. Patients undergoing PCI are at risk for further ischemic events because of procedure-related platelet activation as well as the inherent persistent platelet hyperreactivity and enhanced thrombin generation associated with ACS. Persistent platelet activation following an acute coronary event and/or PCI supports incorporating antiplatelet strategies into the standard medical management of such patients. In this clinical setting, antiplatelet therapies are capable of improving outcomes. Aspirin, thienopyridines, and glycoprotein IIb/IIIa inhibitors, the 3 major pharmacologic approaches to persistent platelet activation, target various levels of the hemostatic pathways and thrombus formation.
authors.affiliation: TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, 350 Longwood Avenue, Boston, Massachusetts 02115, USA. ebraunwald@partners.org
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: Dominick
authors.initials: D
authors.lastname: Angiolillo
authors.forename: Eric
authors.initials: E
authors.lastname: Bates
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhatt
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Mark I
authors.initials: MI
authors.lastname: Furman
authors.forename: Paul
authors.initials: P
authors.lastname: Gurbel
authors.forename: Alan D
authors.initials: AD
authors.lastname: Michelson
authors.forename: Eric
authors.initials: E
authors.lastname: Peterson
authors.forename: Stephen
authors.initials: S
authors.lastname: Wiviott
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use; D006801:Humans; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011725:Pyridines / Q000627:therapeutic use; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011725:Pyridines; C446540:thienopyridine; D001241:Aspirin