title: Developing drugs for use before, during and soon after percutaneous coronary intervention.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is a milestone for treating coronary artery disease (CAD). Antithrombotic therapy is essential to prevent ischemic complications, including the microvascular no-reflow, while minimizing bleeding events.
  
  
  METHODS
  This overview discusses available and developing drugs for PCI including anticoagulants, antiplatelets and treatment of no-reflow.
  
  
  CONCLUSIONS
  For years unfractionated heparin (UFH) has been the unique anticoagulant to be used before and during PCI. Enoxaparin showed similar efficacy and safety, yet, based on recent trials, bivalirudin has been shown to have some benefits, particularly for patients with ST-segment elevation myocardial infarction (STEMI). The evidence concerning new anticoagulants is still preliminary, except for new oral anticoagulants, particularly rivaroxaban that showed intriguing findings and is currently under investigation. Dual antiplatelet therapy (DAPT) is the standard of care after PCI, but new developments have recently emerged. Indeed, ticagrelor and prasugrel are currently recommended over clopidogrel due to their significant reduction of ischemic events in acute coronary syndrome (ACS) whereas clopidogrel remains the choice in stable CAD. Among new agents, vorapaxar and cangrelor showed positive but limited evidence and might be considered at least in selected patients. Conversely, evidence on effective treatments for no-reflow remains limited and would require future dedicated research.
authors.affiliation: a Department of Cardiology , Bern University Hospital , Bern , Switzerland.|b Department of Advanced Biomedical Sciences , Federico II University of Naples , Naples , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gargiulo
authors.affiliation: a Department of Cardiology , Bern University Hospital , Bern , Switzerland.
authors.forename: Aris
authors.initials: A
authors.lastname: Moschovitis
authors.affiliation: a Department of Cardiology , Bern University Hospital , Bern , Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: a Department of Cardiology , Bern University Hospital , Bern , Switzerland.|c Thoraxcenter , Erasmus Medical Center , Rotterdam , The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000628:therapy; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin
keywords: Drugs; anticoagulant; antiplatelet; no-reflow; percutaneous coronary intervention