title: Clinical considerations with the use of antiplatelet therapy in patients undergoing percutaneous coronary intervention.
abstract: Despite the proven benefits of using antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI), a number of key questions remain to be answered. In recent years, clopidogrel dosing strategies among such patients have evolved considerably, with newer approaches involving loading doses prior to PCI and increases in the time interval and loading dosage in an effort to overcome variable responsiveness/hyporesponsiveness to platelet inhibition. Further, the role of glycoprotein (GP) IIb/IIIa antagonists in elective stenting continues to be defined, with recent evidence suggesting that most appropriate use of these agents is in high-risk patients with elevated troponin levels. There appears to be a relationship between the use of GP IIb/IIIa antagonists with clopidogrel loading and attenuation of early inflammatory and cardiac marker release. Strategies to minimize the chance of late stent thrombosis in patients who receive drug-eluting stents (DES) are also under intense investigation. Among some patients receiving sirolimus and paclitaxel DES, current standard long-term antiplatelet strategies may be insufficient. Patient nonadherence to treatment and premature discontinuation and underutilization of antiplatelet therapies by physicians remain important clinical problems with potentially dire consequences.
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: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D001792:Blood Platelets / Q000187:drug effects*; D000077144:Clopidogrel; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019983:Guideline Adherence; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017410:Practice Guidelines as Topic; D015607:Stents; D013927:Thrombosis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine