title: Post percutaneous coronary intervention antiplatelet therapy: current perceptions, prospects and perplexity.
abstract: Dual antiplatelet therapy (DAT) has become standard care for patients undergoing percutaneous  coronary intervention (PCI). Following balloon injury and stent placement, the intima at  the site is distressed, resulting in the activation of coagulation cascade and platelets. In the  case of bare metal stents (BMS), it takes six to eight weeks for the stent surface to be covered  with neointima. However, in the case of a drug-eluting stent (DES), the process of healing is  delayed and neointima may not form for months or even years. To prevent the formation of  platelet thrombi, dual antiplatelet therapy is given as a combination of aspirin and clopidogrel  for three months in a case of BMS and for a minimum of one year in a case of DES.  A prolonged duration of therapy is often required for a subset of patients who are highly prone to  thrombus formation. During most non-cardiac surgeries, dual antiplatelet therapy should be  continued if bleeding can be directly controlled and excessive bleeding will have no adverse  effect on the outcome of surgery. Prasugrel, another thienopyridine, is more potent and faster  acting than clopidogrel, and is therefore of great value in cases of acute coronary syndrome  during PCI, particularly in diabetics. Triple drug therapy, by adding cilastozol, is reserved for  some selected thrombotic lesions. Ticagrelor and cangrelor are two new antiplatelet agents  undergoing various clinical trials. (Cardiol J 2011; 18, 6: 712-717).
authors: Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, 72205 AR, USA.sadippant@hotmail.com
authors: Sadip
authors: S
authors: Pant
authors: Pritam
authors: P
authors: Neupane
authors: K C
authors: KC
authors: Ramesh
authors: Murari
authors: M
authors: Barakoti
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D001241:Aspirin / Q000627:therapeutic use; D000077407:Cilostazol; D000077144:Clopidogrel; D023903:Coronary Restenosis / Q000209:etiology / Q000517:prevention & control*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008670:Metals; D018579:Patient Selection; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013777:Tetrazoles / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013777:Tetrazoles; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077407:Cilostazol; D013988:Ticlopidine; D001241:Aspirin