Controversies in oral antiplatelet therapy in patients undergoing aortocoronary bypass surgery.
Oral antiplatelet therapy with aspirin and clopidogrel is a major strategy to prevent thrombotic events in patients with acute coronary syndromes and patients undergoing percutaneous coronary interventions. Although this therapy is associated with both short- and long-term clinical efficacy, irreversible platelet inhibition and ischemic events associated with premature withdrawal especially in patients treated with drug-eluting stents constitute a particular limitation in patients undergoing surgery. The current review article is focused on the central role of platelets in the occurrence of ischemic events, the significance of antiplatelet therapy, the potential hazards of drug withdrawal in patients needing coronary artery bypass grafting, and future perspectives.
Mahla
Elisabeth
E
Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Metzler
Helfried
H
Tantry
Udaya S
US
Gurbel
Paul A
PA
D000284:Administration, Oral; D001241:Aspirin / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006801:Humans; D010879:Piperazines / Q000008:administration & dosage; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D000068799:Prasugrel Hydrochloride; D011725:Pyridines / Q000008:administration & dosage; D013876:Thiophenes / Q000008:administration & dosage; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; D013876:Thiophenes; C446540:thienopyridine; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine; D001241:Aspirin